
Qass 
Book. 



COPYRIGHT DEPOSIT 



TUB 

MOTHER'S HAND-BOOK: 

A PRACTICAL TREATISE 



Management of Children 



HEALTH and DISEASE, 



AN APPENDIX, 



CONTAINING ARTICLES ON DISEASES AND ACCIDENTS THAT 
MAY SUDDENLY HAPPEN TO GROWN PERSONS. 



BY 



LEVIN J. WOOLLEN, M. D. 



RICHMOND, VA.: 

EVERETT WADDEY CO., PUBLISHERS AND PRINTERS 
189I. 







Entered according to Act of Congress, in the year 1891, by the 

Everett Waddey Company, 

In the office of the Librarian of Congress, 

at Washington, D. C. 



Electrotyped, Printed and Bound 
by Everett "Waddey Co. 



PREFACE. 



r ~PHE following pages have been written with the hope that the infor- 
* mation contained in them will be of use to mothers and others who 
are charged with the responsibility of rearing children. 

The author has endeavored to make the book a useful guide, espe- 
cially to those who live in the country, or in small towns, where medi- 
cal advice cannot always be obtained when desirecl. 

While directions are given for the administration of medicines in 
simple cases, and when emergencies require prompt action, it has been 
the aim of the writer to discourage the mother from assuming the func- 
tions of the physician and undertaking to treat, by means of drugs, dis- 
eases of a serious or complicated character. 

The author believes that to recommend a large number of medicines 
in the treatment of the various diseases to which children are subject 
would confuse the mother and lessen the value of the book. He has; 
therefore, confined his treatment to but few remedies, which he believes 
to be both safe and efficient. 

If a mother has some knowledge of diseases and their management, 
she will often be able to relieve her child of pain and discomfort which 
might otherwise continue for hours. This is especially true when no 
medical practitioner is within easy reach. 

Again, accidents may happen when immediate relief must be obtained 
quickly, or else death may speedily follow. In such cases the mother 
must act promptly and upon her own responsibility. It is believed 
that under such circumstances the information given in the pages of 
this book will be found useful. 

The feeding of infants is a subject of great importance, and consider- 
able space has been devoted to its consideration. 

[3] 



4 Preface. 

It is hoped that those who are about to become mothers will find 
much in the chapters on Pregnancy and on Confinement that will be of 
advantage not only to themselves, but also to their offspring. 

For the benefit of those who live in districts where medical aid can- 
not be secured quickly, an Appendix has been added, in which some of 
those diseases and accidents that may suddenly befall grown persons 
are treated of in plain and concise language. 

A part of the matter contained in the chapter on " The Mother and 
the Physician" has been taken from the valuable work of Professor Fons- 
sagrives, entitled "The Mother's Work," translated by Dr. F. P. Foster, 
and published by G. P. Putnam & Sons, New York, 1872. 

An experience of more than thirty years in town and country prac- 
tice, induces the author to believe that the recommendations given in 
the following pages are judicious, and if strictly followed will lead to 
beneficial results. 



LEVIN J. WOOLLEN. 



1701 Ninth Stkeet N. W., 

Washington, D. C, 1891 



TABLE OF CONTENTS. 



CHAPTER I. 

Pregnancy. Pages. 
The influence of the mother's mode of life during pregnancy upon the child.— Devia- 
tions from health during pregnancy ; The breasts ; The nipples ; Constipation ; Diar- 
rhoea ; Heartburn ; Water-brash ; Piles ; Toothache ; Pruritus or itching ; Pain from 
distention of the abdomen ; Cramps in the legs ; Swelling of the limbs ; Salivation ; 
Vomiting; Hemorrhage; Abortion or miscarriage 11-31 

CHAPTER II. 

Confinement. 

Preparations for confinement. — Labor — Symptoms of approaching labor; First stage of 
labor ; Second stage— Nurse's duty in physician's absence ; Third stage of labor ; 
After-pains; Treatment after labor; The lochia; Flooding; Sore nipples; Abscess 
of the breast ; Milk fever 32-53 

CHAPTER III. 
Attention to the Child soon after Btrtii. 

Directions for the nurse— Tying the cord ; Blue disease ; Washing the child ; Dressing the 
cord ; Clothing the child ; Applying the child to the breast ; Artificial feeding ; Still- 
born children ; Retention of urine ; Constipation ; Inflammation of the breasts ; 
Swelling upon the head; Tongue-tie; Inflammation of the eyes; Ulceration of the 
cord ; Bleeding from the navel ; Chaflngs 54-66 

CHAPTER IV. 

Accidents and Diseases occurring at or soon after P>irth. 

Premature infants ; Suffocation of children in bed ; Deformities ; Mother's marks ; 
Hare-lip; Club-foot; Closure of the bowel; Closure of the urethra; Film over the 
eyes; Bowed legs; Spina bifida; Rupture.— Jaundice ; Lock-jaw; Inflammation of 
the eyes ; Colic ; Erysipelas 67-85 



CHAPTER Y. 
Teething, or Dentition. 

Age at which children cut their teeth; Symptoms of teething; Complications— Vomit- 
ing and diarrhoea ; Aphthae ; Ear-ache ; Catarrh of (he air-passages ; Eruptions.— Treat- 
ment of teething and its complications ; Cutting the gums S6-96 

[5] 



Contents, 



CHAPTER VI. 
Nursing and Feeding. 

Mother should he careful of her own health ; Proper quantity of milk at a nursing ; 
Treatment when mother does not have enough milk ; Proper intervals for nursing ; 
Throwing up the milk; Feeding from a bottle; Preparation of artificial foods—Cow's 
milk ; Diluted cream ; Condensed milk ; Lacto-Preparata ; Patent foods ; Substitute 
for patent foods ; Pearl barley r Gelatine ; Flour ball.— Food for older children . . 96-108 

CHAPTER Vir 

Weaning the Child. 

Dangers of early weaning; Time for weaning; Gradual weaning; Proper kind of food 
and how to give it ; How to cause the child to quit the breast ; Causes that may lead 
to early weaning ; Abscess of the breast ; Nursing sore mouth ; Mother's bad health ; 
When the milk disagrees ; Summer complaint 109-114 

CHAPTER VIII. 
Hygiene op Children. 

Kindness to children; ,The dwelling; The school-house; Bathing; Sleep; Dress; 
Exercise ; Learning'to walk; Exercise in childhood ; Dangers of over-exercise . 115-132 

CHAPTER IX. 

The Mother and the Physician. 

Mothers' conduct towards the physician ; Consultations ; Responsibilities of physicians ; 
Emergencies ; The sick room ; Giving the medicine ; Symptoms to be noticed by the 
mother. 133-144. 

CHAPTER X. 
Signs and Symptoms op Disease. 

Attitude of the child ; The countenance ; Pain ; The cries ; The Voice ; Color of tho 
*- skin ; The sleep ; The cough ; Convulsions ; The eyes ; The pupils ; The tongue ; The 
pulse ; The temperature ; The respiration . 145-156 

CHAPTER XI. 
Diseases op the Mouth Throat and Air-Passages. 

Sore throat or pharyngitis ; Difference between diphtheria and follicular pharyngitis ; 
Treatment of pharyngitis; Enlargement of the tonsils; Thrush, treatment; Acute 
catarrh, treatment; Snuffles— not always a trifling disease— treatment ; Cough, 
treatment 137-171 

CHAPTER XII. 

Other Diseases op the Air-Passages. 
False or spasmodic croup, treatment; True or membranous croup— usually a fatal dis- 
ease — treatment; Bronchitis; or catarrhal fever; Capillary bronchitis; Broncho- 
pneumonia ; Treatment of bronchitis ; Pneumonia or lung fever, divided into three 
stages— treatment ; Pleurisy ; Chronic pleurisy ; Pleurodynia ; Treatment of pleu- 
risy 172-190' 



Contents. 7 

CHAPTER XIII. 
Diseases of the Stomach and Bowels. 
Vomiting, treatment; Constipation, treatment; Diarrhoea, treatment; Peritonitis- 
description of peritonitis— treatment ; Worms, treatment ; Prolapse of the bowel, 
causes, treatment » 191-201 

CHAPTER XIV. 
Diseases op the Stomach and Bowels — Continued. 

Bummer complaint ; Three forms— cholera infantum, ileo-colitis, diarrhcea ; Symptoms 
of cholera infantum ; of ileo-colitis ; of diarrhcea ; Treatment of cholera infantum ; 
of ileo-colitis ; of diarrhoea ; Thrush; Excoriations 202-215 

CHAPTER XV. 

Fevers. 

Ephemeral fever; Symptoms; Treatment.— Intermittent fever; Causes; Symptoms; 
Treatment.— Infantile remittent or Typhoid fever; Causes; Symptoms; Treat- 
ment 216-229 

CHAPTER XVI. 

Nervous Diseases. 

Convulsions; Causes; Symptoms; Treatment.— Chorea or St. Vitus' dance; Symptoms; 
Treatment. — Stridulus laryngismus ; Treatment. — Cerebro-spinal meningitis or spot- 
ted fever; Symptoms;; Treatment. — Hiccough; Treatment. — Night terrors; Symp- 
toms; Treatment 230-243 

CHAPTER XVII. 

Constitutional Diseases. 

Consumption ; Three forms— Caseous, Tubercular, and Fibrous consumption ; Difference 
between consumption in adults and children ; Treatment.— Scrofula ; Affection of 
the glands ; of the eyes; of the bones ; Treatment.— Pickets ; Causes; Treatment . 244-258 

CHAPTER XVIII. 

Eruptive Diseases. 

Prickly heat; Itch; Nettle rash ; Dandruff; Red gum; Ringworm; Shingles; Fever 
blisters ; Simple eczema ; Chronic eczema ; Milk-crust ; Treatment of Eczema ; Scar- 
let rash ; Treatment 259-2?2 



CHAPTER XIX. 
Acute Contagious Diseases. 

Mumps ; Symptoms ; Treatment. — Whooping cough ; Symptoms ; Complications ; Treat- 
ment. — Diphtheria; Three forms.— catarrhal, croupous, and septic ; Symptoms of the 
catarrhal torm ; of the croupous ; of the septic ; Treatment of Diphtheria .... 273-284 



8 Contents. 

CHAPTER XX. 

Acute Contagious Diseases — Continued. 

Scarlet fever ; Three forms— the simple, the anginose, and the malignant ; Dropsy fol- 
lowing scarlet fever ; Treatment of scarlet fever.— Measles ; Complications ; Treat- 
ment— Rotheln or German measles ; Difference between rotheln and true measles ; 
Treatment.— Chicken-pox ; Difference between chicken-pox and varioloid ; Treat- 
ment of chicken-pox 285-29S 

CHAPTER XXI. 

Accidents and Injuries. 

Burns and scalds ; Gunpowder injuries ; Swallowing foreign substances ; Fractures and 
dislocations; Sprains; Bruises; Wounds; Frost-bite; Sore ears; Lime in the 
eyes , 299-313 

CHAPTER XXII. 
Accidents and Injuries — Continued. 

Drowning ; Internal poisons— Acids ; Ammonia ; White vitriol ; Belladonna ; Camphor ; 
Corrosive sublimate ; Jimson weed ; Arsenic ; Paris green ; Oxalic acid ; Opium ; 
Laudanum ; Phosphorus ; Tartar emetic— External poisons — Poison ivy ; Poisonous 
insects ; Snake-bite.— Foreign bodies in the ear ; in the eye ; in the air-passages ; in 
the nose.— Choking.— Accidents from lightning 314-330 

CHAPTER XXIII. 
Miscellaneous Diseases. 
Vaccination ; Selection of matter ; How to vaccinate.— Purpura; Causes ; Purpura hemor- 
rhagica; Treatment of purpura.— Bleeding from the nose; Treatment.— Ear-ache ; 
Symptoms ; Treatment.— Wetting the bed ; Treatment.— Warts ; Treatment . . . 331-339 

CHAPTER XXIY. 

Miscellaneous Subjects. 
Disinfectants— Quicklime ; Chloride of lime ; Copperas ; Carbolic Acid ; Fumigation- 
Protection from contagious diseases— Heredity ; The transmission of diseases ; Hemor- 
rhage ; Difference between arterial, venous, and capillary hemorrhage ; Arrest of 
hemorrhage 340-354 

CHAPTER XXY. 

Medicines. 
How medicines should be kept ; Alcohol ; Alum ; Aromatic Spirits of Ammonia ; Liquor 
of Ammonia; Muriatic Acid; Calomel; Dover's Powder; Godfrey's Cordial; Gly- 
cerine ; Tincture of Iodine ; Syrup of Ipecacuanha ; Persulphate of Iron ; White 
Lead ; Laudanum ; Sugar of Lead ; Mustard ; Sweet Spirits of Nitre ; Sweet Oil ; 
Paregoric ; Chlorate of Potash ; Rhubarb ; Tannin ; Vaseline ; Oxide of Zinc ; Pre- 
cipitated Carbonate of Zinc ; Sulphate of Zinc ; Adhesive Plaster '. . . 355 



Contents. 
APPENDIX. 



CHAPTER I. 

Prevention of Disease. 

Effects of living in over-heated rooms.— Effects of exposure to cold and wet.; Of consti- 
pation of the bowels ; Of continued hard labor ; Farmers' wives over-taxed with 
hard work ; Bad effects of over-eating ; Danger;of attendance upon burials ; How to 
avoid malarial disease ; Control of the passions 367-374 

CHAPTER II. 
Pain : Its Significance and Treatment. 

The cause of pain ; Pain in the head ; In the neck ; In the chest ; In the region of the 
heart ; In the spinal column ; In the back ; In the abdomen ; In the hip ; In the ex- 
tremities.— Treatment of pain: In headache ; In sick headache ; In muscular rheu- 
matism; In acute rheumatism; In lumbago; In neuralgia; In pleurisy; In angina 
pectoris ; In the abdomen ; In hysteria ; In sciatica ; In inflammation of the 
joints 375-384 

CHAPTER III. 
Diseases of the Bowels. 

Cholera morbus; Causes; Symptoms; Treatment.— Diarrhoea ; Causes; Chronic diar- 
rhoea ; Treatment of diarrhoea. — Dysentery or flux ; Causes ; Symptoms ; Chronic 
dysentery; Treatment of dysentery 3S5-398 

CHAPTER IV. 
Hepatic, Intestinal and Nephritic Colic. 

Hepatic or bilious colic; Causes; Symptoms; Treatment.— Intestinal or wind colic; 
Causes ; Symptoms ; Treatment. — Nephritic or kidney colic ; Causes ; Symptoms ; 
Treatment 399-403 

CHAPTER V. 

Miscellaneous Subjects. 
Fainting ; Causes ; Treatment.— Sunstroke ; Causes ; Symptoms ; Treatment.— Hemop- 
tysis or bleeding from the lungs ; Causes ; Symptoms ; Treatment. — Hieruetamesis 
or bleeding from the stomach; Causes; Symptoms; Difference between bleeding 
from the stomach and from the lungs ; Treatment of ha?metamesis 404-414 

INDEX 415-419 



The Mother's Hand-Book. 



"pregnancy 






THE INFLUENCE OF THE MOTHER'S MODE OF LIFE, DURING 
PREGNANCY, ON THE CHILD. 

EVERY woman about to become a mother should bear 
in mind that her offspring will be influenced to a great 
extent by her bodily and mental condition during the period 
of pregnancy. The knowledge that any violation of the 
laws of health on her part will affect her unborn babe 
should teach her to be guarded in her actions and longings, 
and to maintain, as far as possible, a cheerful disposition 
and an agreeable frame of mind. 

Authentic cases are recorded where mothers, agitated by 
distressing anxieties during pregnancy, have given birth to 
children who were a prey to nervous or convulsive diseases, 
or displayed a timidity of character that lasted through life. 
A sudden shock to the mother, caused by witnessing a fright- 
ful catastrophe, or a disgusting object, may injuriously affect 
her unborn child; but continued nervous excitement, a state 
of fear, anger or grief, borne day after day, or week after 
week, is much more apt to stamp its effects upon the child 
than a sudden fright, or shock of any kind, that soon passes 
away. 

The presence of deformities, or stains, marks or moles, 
that are sometimes observed on the bodies of infants, are 
often accounted for by the mother on the ground thai she 

[Hi 



12 The Mother's Hand-Book. 

was frightened by some object, or that she had a longing for 
some fruit that, in her opinion, resembled the "mark" on 
her child. Such views are erroneous, and rarely, if ever, 
have any foundation in truth. 

Although the mother's mark, or other physical deformity 
of a child, is rarely, if ever, caused by a " scare" or a " long- 
ing," yet there is a direct relation between the state of health 
and feelings of a mother, while pregnant, and the general 
constitution of her child. Thus, if the mother, during the 
term of her pregnancy, be nervous, fretful and passionate, 
she may expect to give birth to a child possessing in some 
degree the same qualities of temperament. 

It is well known that different children of the same pa- 
rents are often very unlike in their tastes, habits and dispo- 
sitions. One may be gentle, kind and even-tempered, while 
another is entirely different. The probabilities are that in 
many cases this difference of temperament is due to the 
mother's mental condition and peculiarities at the time she 
was carrying her child in her womb. 

It therefore becomes the sacred duty of every mother, from 
the moment of conception, to endeavor to maintain the high- 
est degree of mental and bodily health possible. Such an 
effort entails upon her no real sacrifice; and while it adds 
to her own happiness and freedom from many ills, it will 
conduce to the future welfare of her offspring. 

It should be remembered that pregnancy is a physiolo- 
gical process, and that under favorable conditions there 
should be but little deviation from ordinary good health. 
The idea that it is a period of great danger is not well 
founded, unless it is rendered so by mismanagement on the 
part of the mother herself. But while it is a physiological 
condition, and not necessarily connected with any great de- 
parture from usual health, yet during this period slight 
causes may produce greater disturbances in the patient's 



Pregnancy. 13 

system than would be the case under other circumstances. 
This knowledge should teach the mother that while she can 
rest assured of a safe delivery in the end, if she pays strict 
attention to the laws of health, and exercises care and pru- 
dence in her methods of living, yet she must not forget that 
now she must be even more guarded than before; otherwise 
by her own imprudence and folly she may lay the foundation 
for troubles that are liable to last through life, and seriously 
affect the well-being of her offspring. 

" Gloomy, painful and harassing impressions should be 
guarded against, and good nature, equanimity and cheerful- 
ness cultivated by all around her." She should engage in 
healthful and invigorating occupations, such as will insure 
her a proper amount of bodily exercise and at the same time 
give employment to her mind, thereby preventing her from 
dwelling too much upon her condition and the dangers that 
she fancies are in store for her. 

Attention must be given to the necessity of breathing 
good fresh air, to sleeping in a room that is properly venti- 
lated and not too dark, to exercise in the open air, to diet, 
and to all the ordinary conditions of good health. In regard 
to diet, it may be said that the food should be of a nourish- 
ing character and easily digested. 

A healthy woman need not make much change in her 
diet during pregnancy. If her appetite is good, and her di- 
gestion perfect, she may eat more than before, since there is 
an increased demand upon her to furnish nourishment for 
her unborn child. 

It is important that the mother should not restrict herself 
to a too limited amount of food, thinking thereby to relieve 
herself of heartburn, flatulence, nausea and other troubles 
that attend upon indigestion. 

The "longings" for certain articles of diet, that some 
women indulge in during pregnancy, are rarely seen in 



14 The Mother's Hand-Book. 

one of good health and well constituted mind. They are 
usually found in delicate, nervous and irritable women, who 
have not a proper occupation to engage their time and 
thoughts. Much can be done in these cases by advising the 
patient to fix her mind on more wholesome matters, and at 
the same time to partake of a proper amount of plain, mild 
food. Occasionally, in confirmed cases, it may be advisable 
to yield to some extent to the depraved longings of the pa- 
tient. 

Pregnancy and childbirth may be seriously affected by 
the mother's method of dressing before becoming pregnant. 

The young wife who has reason to believe herself preg- 
nant should so arrange her dress as to avoid unduly com- 
pressing any part of the body. The chest must be left free 
to move without restraint at each act of respiration. The 
clothes must fit loosely around the waist, as pressure upon 
the abdomen is not only hurtful but often dangerous. 

Those who from childhood have been encased in unyield- 
ing stays and corsets will probably, when they become 
mothers, pay the penalty of their previous folly. The hu- 
man body needs no artificial aids to its shapeliness, for, if 
there be no undue pressure upon any part of it, and if per- 
fect freedom be given to its muscles and various organs, the 
figure will develop gracefully and elegantly. 

But if a young married woman has been accustomed from 
childhood to the use of stays and corsets, it may not be best 
to lay them aside at once. Long continued use may render 
their support, to some extent, necessary; and in such cases 
it will be well to substitute a corset made of thin whalebones 
for the stiff steel blades in common use. Even this should 
be worn loosely, so as to admit of free respiration and the 
gradual enlargement and ascent of the womb. 

" If women could be convinced that, as a general rule, the 
danger attending confinement in childbed is in proportion 



Pregnancy. 1 5 

to tlie previous sound or unsound condition of the system, 
and to good or bad management at the time, they would be 
much more anxious than they are to conform to the laws of 
health, both for their own sake and for the sake of the child 
whose welfare is so largely committed to their trust. " 

DEVIATIONS FROM HEALTH DURING PREGNANCY. 

As pregnancy has such a wonderful effect upon the womb, 
changing its size, its form, and even its structure, it is 
scarcely possible that a woman can pass through the preg- 
nant state without the various functions of the body becom- 
ing greatly affected. In a few cases the changes in the 
system, wrought by pregnancy, seem to be salutary, the pa- 
tient enjoying better health than at any other period. In a 
majority of cases, however, disagreeable symptoms are expe- 
rienced as the result of the changed condition of the uterus. 
These troubles, which in many are so slight as to amount 
merely to discomforts, are in other cases so great as to 
seriously impair the health of the patient. 

The breasts must receive attention during pregnancy. The 
skin covering the nipples is thin, sensitive, and liable to be- 
come inflamed from slight causes; hence the dress should 
be arranged loosely, so as to avoid all pressure upon the 
parts. 

If the breasts become swollen and painful, causing the 
patient much trouble and anxiety, they should be gently 
and carefully rubbed with warm sweet oil once or twice a 
day until the trouble subsides. 

During the latter months of pregnancy the nipples should 
be examined, and if they be flattened or sunken, measures 
must be taken to make them prominent, so that the child 
maybe able to suck. This can be done by frequently placing 
the inverted bowl of a clay pipe over them and drawing 
them out gently by suction. Neglect of this precaution may 



16 The Mother's Hand-Book. 

give rise to a great deal of trouble and suffering, ending in 
sore nipples, and, in some cases, in abscess of the breasts. 

A useful wash for nipples during the last month of preg- 
nancy is made by dissolving a tablespoonful of tannin in a 
gill of alcohol, to which a gill of water has been added. This 
can be applied morning and night by dipping a camel's hair 
pencil, or a feather, into it and touching the nipples. No 
rubbing or friction is permissible, merely wetting the nipple 
being sufficient. A nipple treated in this manner is not 
likely to become cracked, or sore from the efforts of the child 
in sucking. 

Women usually complain of constipation of the bowels dur- 
ing the period of pregnancy. The tendency to this trouble 
should be counteracted, if possible, by a proper regulation 
of the patient's habits and diet. She should eat brown 
bread and plenty of fruit, such as stewed prunes, Stewed 
rhubarb, baked pears, baked apples, oat-meal mush with 
fresh milk, etc. An occasional injection of a pint of tepid 
water will aid in overcoming the trouble. 

Much assistance can be given the bowels in cases of con- 
stipation by visiting the water closet at a certain hour each 
morning and remaining quite a while, gently persuading the 
bowels to act. 

If these measures fail to correct the trouble, recourse may 
be had to mild aperient medicine; but patients should re- 
member that medicines should be used only after the means 
above mentioned have proved ineffectual. 

Castor oil is an old and safe remedy, but its disgusting 
taste renders its use very objectionable to most persons. It 
should be taken in small doses, and if properly administered 
the patient will scarcely taste it. The best way of adminis- 
tering castor oil is to take a small cup and rinse it out with 
hot water; then squeeze into it a tablespoonful of the juice 
of an orange; then pour in the oil, and on top of this 



Pregnancy. 17 

squeeze a little more orange juice. Now rinse the mouth 
with some of the juice of the orange, and quickly swallow 
the oil, taking pains that none shall stick to the lips. Have 
a wet napkin at hand and thoroughly wipe the lips before 
taking a breath, and the oil will not be tasted. If an orange 
be not at hand, essence of cinnamon or peppermint, or some 
similar liquid, can be substituted. If oil cannot be taken, 
recourse may be had to the citrate of magnesia, or a Seid- 
litz powder early in the morning. 

Pills of castile soap, softened with a few drops of sweet 
oil, of which three or four may be taken at bed-time, will 
often serve a good purpose. 

Diarrhoea. — Sometimes a pregnant woman is subject to 
diarrhoea. It may be the result of previous constipation, 
nature making an attempt, in this manner, to get rid of the 
long retained fecal matter. 

If such be the cause, the proper remedy is a mild aperient, 
such as a syrup made of the root of Turkey rhubarb, or, if 
preferred, the citrate of magnesia, or a Seidlitz powder. 
For a few days the diet must be mild and bland, composed 
of such articles as chicken broth, oat-meal gruel, rice, tapi- 
oca and kindred articles. If the diarrhoea is attended with 
much pain, relief can usually be obtained by placing warm 
applications over the bowels. 

In cases that are stubborn, and especially if there be a ten- 
dency to flux, an occasional dose of Godfrey's Cordial (a 
dessertspoonful), added to a like quantity of the aromatic 
syrup of rhubarb, will afford great relief. 

Heartburn is a most common and distressing complaint, 
and sometimes continues throughout the whole course o( 
pregnancy; but usually some relief is obtained about the 
close of the eighth month. It is a sign of indigestion and 
is caused either by overtaxing the stomach with food, or by 
pressure made upon it by the womb, or by both. 



18 The Mother's Hand-Book. 

The patient should reduce the quantity of food at each 
meal, and be more careful of the quality, eliminating from 
her diet such articles as do not agree with her. If the heart- 
burn continues, temporary relief can often be obtained by 
taking a large teaspoonful of calcined magnesia in a wine- 
glassful of warm water. If this does not afford relief the 
patient may take a teaspoonful of the bi-carbonate of soda 
(common baking soda) in a wine-glassful of cold water. 

Water Brash. — This consists of an eructation of a thin, 
watery fluid, often in large quantities, from the mouth, and 
is a usual accompaniment of heartburn. In some cases 
water-brash continues during the whole term of pregnancy. 

The same remedies used in heartburn are proper in this 
affection, and, in addition, a teaspoonful of charcoal in a 
half glassful of water should be taken occasionally. 

Piles. — Pregnant women are often afflicted with piles, 
which, according to their situation, are called internal or 
external. They may be either blind or bleeding. The lat- 
ter may give rise to considerable loss of blood when at stool, 
and therefore the patient should relieve her bowels as quickly 
as possible, and remain over the stool no longer than is ne- 
cessary. If the piles be internal and protrude only during 
straining at stool, the patient must carefully replace them 
with her fingers as soon as the bowels are emptied. If the 
piles cannot be easily returned, and are painful, the patient 
should occasionally sit in a vessel containing water as hot as 
can be borne. This will greatly relieve the pain and in- 
flammation; after which the piles should be well anointed 
with an ointment made by mixing a teaspoonful each of gum 
camphor and powdered galls with four tablespoonfuls of 
fresh lard. 

Piles are always rendered more painful by a constipated 
condition of the bowels. When it becomes necessary to re- 
sort to medicine to keep the bowels open the best remedy 



Pregnancy. 19 

will be found to consist of equal parts of flour of sulphur 
and cream of tartar, to be well mixed. A large teaspoonful 
of this mixture can be taken each morning in a little molas- 
ses or thick syrup. If the patient objects to the sulphur and 
cream of tartar mixture, she can take either the citrate of 
magnesia or Tarrant's Seltzer powder. 

An occasional injection, carefully made, of a pint of warm 
water will afford great relief, and may sometimes take the 
place of purgative medicine. Care must be exercised in in- 
troducing the point of the syringe to avoid injuring the piles. 

The disease usually lasts during the whole period of preg- 
nancy; but temporary relief can be obtained by following 
the directions above given. 

Toothache. — Pregnant women are liable to suffer greatly 
from toothache, and there is a popular belief, sanctioned by 
some medical writers, that a tooth ought never to be ex- 
tracted during pregnancy. This is erroneous; for, while a 
pregnant woman ought not to have a tooth extracted for a 
trifling or transient toothache, she should not hesitate to 
have the operation performed when she finds it impossible 
to obtain relief by ordinary remedies, and when the pain has 
been so severe and long continued as to deprive her of rest 
and sleep. The only danger in extracting teeth under these 
circumstances is in the shock of the operation, which, in a 
very delicate, nervous woman, might possibly lead to a mis- 
carriage. But this very rarely occurs; at least, such cases 
have never come under my observation. The constant and 
severe pain of an aching tooth, which destroys sleep and re- 
duces the patient to a weak, exhausted and nervous condition, 
is more likely to lead to a miscarriage than the mere opera- 
tion of extracting a tooth. 

But before the patient submits to such an operation, 
every means of allaying the pain by local applications 
should be tried. If the tooth bo much decayed and the 



20 The Mother's Hand-Book. 

hollow part exposed, it can be filled with a bit of cotton that 
has been soaked in oil of cloves, or in a mixture of cloves 
and chloroform. Sometimes the chloroform alone, or equal 
parts of chloroform and laudanum, will answer a good pur- 
pose. If this does not give relief, the cotton may be wet 
with creosote and placed in the cavity. If creosote is used, 
it must not be permitted to touch the gums, tongue, or 
cheeks, as it will burn them. To avoid this, the parts 
should be protected by placing cotton in the mouth, leaving 
only the tooth exposed. With care, the creosote can then 
be inserted in the cavity without danger of its touching the 
gums or other parts of the mouth. If the aching tooth be 
in the upper jaw, it is not likely that such applications will 
afford the same relief as they would if it were a lower one. 

If these remedies do not ease the pain, recourse must be 
had to the application of flannel wrung out of hot water and 
applied to the side of the face. If properly applied the hot 
cloths will nearly always give relief. Take a piece of flan- 
nel a yard or more in length, and of the usual width; 
fold it the whole length, making it about six inches wide, 
Now double it so that it will be only half a yard long. 
Dip this into very hot water in such manner as to wet the 
whole flannel except about six or eight inches of the free 
ends. Squeeze the surplus water out of the flannel, and fold 
the wet part upon itself, forming a compress about six inches 
square. Fold the free ends of the flannel (which are dry) 
over the wet compress on each side, and apply it to the 
face. 

It should be cautiously applied at first, as the water should 
be hotter than the patient can bear, until she gradually be- 
comes used to it. Let it touch the face for a second, with- 
drawing it if too hot, and then again cautiously applying it 
until the patient can permit it to remain. It must be re- 
newed every five or ten minutes until relief is obtained. 



Pregnancy. 21 

Pruritus, or itching of the vagina and neighboring parts, 
is sometimes so severe as to almost wear out a patient both 
mentally and physically. The sleep is destroyed at night 
by the intense itching, and to relieve it the patient is com- 
pelled to rub the part, thus aggravating the disease. 

The skin around the vagina is the usual seat of pruritus, 
and from the irritation produced by rubbing it soon be- 
comes inflamed and ulcerated. The disease often extends 
to the mucous membrane inside of the vagina, causing in- 
flammation and swelling of the structures. 

The symptoms are usually difficult to relieve, some cases 
requiring the use of a variety of remedies before the disease 
is controlled. 

The affected parts should be bathed with water as hot as 
can be borne, to which a little baking soda has been added, 
and afterwards wet with a mixture consisting of one part of 
alcohol and two of water. If this wash causes severe smart- 
ing it can be weakened by adding more water. Sometimes 
a solution of sugar of lead, an even teaspoonful to a half 
pint of water to which a tablespoonful of laudanum has 
been added, affords considerable relief. When the parts 
have dried, after having been wet with the wash, they 
should be dressed with the oxide of zinc ointment, to which 
powdered gum camphor has been added in the proportion 
of a teaspoonful to an ounce of the ointment. Before mix- 
ing the camphor with the ointment, it should be dissolved 
by the addition of a few drops of alcohol, after which it can 
be readily powdered. In some cases great relief follows the 
use of an ointment consisting of a teaspoonful each of chlo- 
ral and camphor with two teaspoonfuls of glycerine and a 
tablespoonful of vaseline. The ingredients should be well 
mixed and applied night and morning. 

In some severe cases, where the disease was limited to the 
skin around the vagina, I have had excellent results from 



22 The Mother's Hand-Book. 

painting the diseased parts with white lead after the manner 
described in the article on burns. 

Pain from distention of the abdomen may be troublesome 
in some cases. All that is necessary to be done is to gently 
rub the abdomen with warm sweet oil several times a day 
until relief is obtained. 

Cramps in the legs, from pressure of the womb on the large 
nerves at the brim of the pelvis, are quite common during 
the latter months of pregnancy, being usually worse at night 
than during the day. The treatment consists of firm fric- 
tion with the hand over the painful spot. In very bad cases 
it may be necessary to wear an elastic stocking to make 
equable pressure on the limb. 

Swelling of the limbs occurs in the latter months of preg- 
nancy. Unless the swelling is unusually great, all that is 
needed is to lie down occasionally through the day, with the 
limbs slightly elevated, to favor a return of the venous 
blood to the heart. In very severe cases, where there is 
danger of the veins bursting, it may be necessary to wear 
an elastic stocking to support the circulation. 

If the-face and upper extremities become swollen, and es- 
pecially if this condition is accompanied with severe and 
persistent headache, the symptoms are of a more serious char- 
acter, and may indicate a morbid condition of the kidneys. 
Under such circumstances the patient should without delay 
consult a competent physician and have him examine her 
urine to ascertain if it contains albumen. Puffiness of the 
face and eyes, with severe headache, and a continuous sharp 
pain at the pit of the stomach, occurring in the latter part 
of pregnancy, are symptoms that must not be overlooked; 
and women suffering from them should place themselves 
under medical treatment, in order to avoid serious trouble 
during, or after, their confinement. 



Pregnancy. 23 

Salivation. — Sometimes pregnant women are troubled with 
a too free secretion of saliva, which causes them to be almost 
constantly spitting. At night, during sleep, the saliva flows 
from the mouth and wets the pillow upon which the patient's 
head rests. 

The trouble, though annoying, is not attended with dan- 
ger, and usually subsides without treatment. Some relief, 
however, may be obtained by using a mouth wash made by 
dissolving a heaping tablespoonful of tannin in a half tea- 
cupful of alcohol and a teacupful of water. If a spoonful 
of powdered myrrh be added to the mixture it will increase 
its usefulness. 

The vomiting of pregnancy presents two different forms. 
The first, called " morning sickness," is more a matter of dis- 
comfort and annoyance than of danger. The second, or 
irrepressible vomiting, is always a severe and sometimes a 
dangerous complaint. 

In the first, or simple form, the vomiting often commences 
in the very earliest stages of gestation. At other times it 
does not appear until toward the third or fourth month. 
Occasionally it begins in the first month and subsides at the 
end of the fourth, only to reappear near the close of preg- 
nancy. As an ordinary rule, the vomiting lasts from six to 
eight weeks, but it may extend over a period of four or five 
months, and in exceedingly rare cases it continues during 
the whole term of pregnancy. Some women are subject to 
the complaint every time they become pregnant, while others 
pass through several gestations without any digestive trou- 
bles whatever. In many cases the vomiting is confined to 
the forenoon of each day, and it may be unattended with 
any impairment of the general health — the woman continu- 
ing in her usual flesh and strength. 

The second, or irrepressible form of vomiting, is a much 
more serious disease than the foregoing. It may begin sud- 



24 The Mother's Hand-Book. 

denty as a severe complaint, but more often it commences 
as a simple vomiting, and gradually assumes an irrepressi- 
ble character; it being impossible to distinguish, with accu- 
racy, the period of transition from the simple to the graver 
form. 

In this variety of the disease the vomiting is frequent and 
occasions the rejection of nearly all the food and drink 
which the patient takes. Bilious matter, mixed with mucus, 
in addition to the food and drinks, are thrown up from the 
stomach. The breath has a sour, fetid smell, and in some 
cases the patient has fever. 

The discharges from the bowels are usually of an acid 
nature, and may contain mucus mixed with blood. 

Sometimes the aversion to food is so great that it is with 
difficulty that the patient can be persuaded to take enough 
nourishment to sustain life. Grave signs of insufficient 
nutrition soon appear, and the patient rapidly becomes 
weak and emaciated, with altered features. 

In the worst cases the symptoms continue to grow more 
severe; the attacks of vomiting are frequent and violent, 
while the emaciation rapidly increases; the fever becomes 
more marked; the mouth is dry, the thirst is intense, and 
the breath is extremely offensive, the odor being percepti- 
ble throughout the room. 

Although death from this disease is exceedingly rare, yet 
fatal cases have been reported — the patients dying of exhaus- 
tion. Delirium, fainting, profound sleep, with other symp- 
toms of disturbance of the brain, usher in the fatal result. 

In the advanced stages of the disease, when life seems to 
be in great peril, the induction of premature labor has been 
practiced, it being in some cases the only means by which 
life can be saved. 

Treatment: The patient should confine herself to a mild, 
nourishing diet, easy of digestion, and should avoid fluids 



Pregnancy. 25 

as much as possible. The bowels should be regulated by 
mild laxatives, such as Husband's Magnesia, or Tarrant's 
Seltzer powder. If the vomiting becomes very troublesome, 
temporary relief may occasionally be had by lying in bed 
during the hours when the suffering is usually the greatest. 

When the trouble is slight, and occurs in the morning 
only, small quantities of iced tea, iced mineral waters, or 
champagne, and sometimes small pieces of ice, can be taken 
with advantage. 

When the vomiting takes place after a certain meal, say 
breakfast, the patient being unable to retain the food eaten, 
such meal should be a very light one, and the deficiency in 
the amount of food taken should be supplied by eating more 
at dinner and supper. 

If these measures prove unsuccessful, it may be necessary 
to take one-twentieth of a grain of morphine before the meal. 

In the irrepressible form of vomiting, where the patient's 
flesh and strength rapidly fails because of her inability to 
retain enough food to nourish the body, a physician must be 
consulted, and if ordinary remedies fail to afford sufficient 
relief to warrant the belief that the woman can safely go to 
her full term, the question of the induction of premature 
labor may be considered. 

Hemorrhage. — Owing to a variety of causes, pregnant wo- 
men may be subject to a loss of blood from some portion of 
the genital organs. Sometimes the bleeding commences 
soon after conception, being, in some cases, continuous, 
while in others it comes on at regular intervals, but the dis- 
charge being slight, it creates no great alarm. The bleeding, 
in such cases, most probably comes from the mouth or neck 
of the womb — they being ulcerated or congested — and is un- 
attended with danger to life. 

Hemorrhage from the uterus, occurring during the first six 
months of pregnancy, may give rise to, or accompany, abor- 
tion. 



26> The Mother's Hand-Book. 

Hemorrhage during the latter months of pregnancy is 
caused by partial separation of the after-birth from the sur- 
face of the womb, and is attended with danger to life. In all 
such cases a physician should be consulted without delay. 

When the after-birth is implanted over or around the in- 
ternal mouth of the uterus, hemorrhage always takes place 
when the womb begins to dilate during the first stage of 
labor. Such hemorrhages are styled unavoidable. If the 
after-birth be attached to the inner surface of the womb at 
some point other than at or near its mouth, and hemor- 
rhage takes place, it is owing to a separation of some portion 
of the after-birth from accidental causes. Hemorrhages of 
this character are called accidental, and may be profuse or 
slight according to the amount of placental detachment 
that has occurred. 

Ordinarily, accidental as well as unavoidable hemorrhage 
shows itself externally by profuse gushes of blood from the 
womb. This is not, however, always the case, for some- 
times, though rarely, when the after-birth is partially sepa- 
rated by accident, the blood that escapes may be retained in 
a kind of capsule formed by the separated portion of the 
after-birth and the inner surface of the womb, constituting 
what is known as concealed hemorrhage. In such cases the 
effused blood may be entirely concealed, or a few clots may 
escape externally while the greater portion remains pent up 
within the womb. Of course, under such circumstances the 
amount of blood that escapes externally is no criterion by 
which to judge of the patient's danger. 

The most dangerous form of hemorrhage to which a 
pregnant woman is liable is that caused by partial separa- 
tion of the placenta. If the after-birth be implanted around 
the mouth of the womb, constituting what is known as pla- 
centa praevia, there is certain to be flooding of an alarming 
character at some period before actual labor commences. 



Pregnancy. 27 

The hemorrhage may come on suddenly and in gushes, 
and unless promptly arrested it will soon exhaust the patient. 
The bleeding may cease soon after the woman takes to her 
bed, or it may continue until life is imperilled. It may 
cease spontaneously, only to recur at some future time with 
equal intensity. During confinement, cases of placenta 
praevia (which, fortunately, is a very rare complication) are 
always attended with considerable flooding, and require the 
greatest skill on the part of the attending physician for their 
safe management. A woman suffering from such hemor- 
rhage during pregnancy should, as soon as possible, consult 
a physician and place herself under his treatment. If the 
flooding be so profuse as to threaten life during the absence 
of her medical adviser, she should lie quietly in bed, with 
her hips raised higher than her shoulders and head, and, if 
the hemorrhage continues, the nurse should proceed to plug 
the vagina according to the directions given in the article on 
abortion, to which the reader is referred. 

MISCARRIAGE, OR ABORTION. 

The term miscarriage, or abortion, is applied to those cases 
where the foetus passes from the womb before the seventh 
month of pregnancy. After the seventh, and before the 
ninth, month it is called premature labor. 

A miscarriage may be produced by a variety of causes, 
probably the most frequent being intentional interference 
with the process of gestation, either by the use of instru- 
ments or the taking of certain powerful medicines with a 
view of destroying the foetus, and preventing the birth of a 
living child. Aside from the moral guilt that a mother 
must feel when she reflects that she has purposely destroyed 
the life of her own offspring, she soon realizes that by her 
own sinning she has brought upon herself physical ailments 
that will probably last as long as she lives. Abortions, pur- 



28 The Mother's Hand-Book. 

posely induced, are more dangerous to life than natural 
labors, and besides, they are, in nearly every instance, more 
or less destructive to the future health of the patient. In 
the cities and large towns, the crime of abortion is common, 
and women who submit to it seem to have but little thought 
of its sinfulness, or its destructive influences on their lives 
and future health. 

The causes of natural miscarriages may exist either in the 
ovum or foetus, or in the mother herself. The foetus may 
be affected by disease inherited from one of its parents, as 
syphilis ; the cord may be twisted in such manner as to cut 
off the circulation of blood in it ; or the after-birth may be- 
come detached from the womb prematurely ; or be attached 
too low down in the womb, or perhaps over the mouth of the 
uterus — a condition that gives rise to dangerous flooding pre- 
vious to or during labor. Where from any cause there is 
an arrest of development of the foetus, miscarriage nearly 
always results. 

On the part of the mother, diseases, such as small-pox, 
measles, erysipelas, pneumonia, and other affections, may 
lead to miscarriage. Shock to the nervous system, when 
severe, may produce abortion. Injuries from falls, blows, 
etc., may terminate in the same way. Chronic inflammation 
of the lining membrane of the womb, tumors of the uterus 
or of the neighboring parts, as well as some displacements 
of the womb, may give rise to this trouble. A woman who 
has once miscarried at a certain month is liable to a subse- 
quent miscarriage at the same elate, and where two or more 
abortions have happened at the same period of gestation, it 
is almost impossible thereafter for a woman to carry a child 
to full term. 

When abortion is threatened the patient usually begins to 
bleed from the womb before there are any pains to attract 
her attention. Sometimes pains of an intermittent charac- 



Pregnancy. 29 

ter, situated within the pelvis, are felt before the hemorrhage, 
but this is usually rare. The amount of blood lost varies 
greatly in different cases. Often it is small in quantity, and 
continues for a long time without pain. After awhile pains 
come on and the foetus is expelled. In other instances the 
hemorrhage is sudden, and from the great amount of blood 
that is lost it becomes dangerous. The after-birth in these 
cases has been implanted over the mouth of the womb, con- 
stituting what is known as placenta praevia, and as the womb 
dilates the placenta is separated from it, exposing the large 
blood vessels, which pour out their contents in great quanti- 
ties. 

Sometimes a miscarriage begins with rupture of the mem- 
branes and a discharge of water from the womb. After 
awhile pains come on and the foetus is expelled. 

In the treatment of abortion it must be ascertained if the 
trouble is only threatened, or if it is in actual progress. 

In threatened abortion the patient should go to bed and 
remain in a recumbent position. The diet should be mild 
and non-stimulating. Warm drinks must be discarded, and 
thirst should be relieved by cold water. If the pains are 
at all severe, an injection consisting of a half teaspoonful 
of laudanum in a gill of starch water can be thrown up the 
bowel. 

If the symptoms continue to increase, medical assistance 
must be obtained without delay. 

If a woman has previously miscarried at a certain period 
of gestation, it is essentially necessary that as she approaches 
the dangerous period in subsequent pregnancies she should 
use the greatest care and caution possible to escape the 
threatened danger. She must then lie down and rest at fre- 
quent intervals during the day. She should neither lift 
heavy weights nor perform hard manual labor, but take suffi- 
cient exercise to keep up a good appetite and digestion. The 



30 The Mother's Hand-Book. 

bowels ought to be kept regular, but harsh purgative medi- 
cines must be avoided. If she has pain in the pelvic organs 
she should occasionally take a laudanum and starch-water 
injection as above recommended, and remain in bed until 
relieved. By using great prudence and care she may pass 
the danger line and carry her child to full term. 

When abortion has actually commenced and there is no 
hope of its arrest, no time should be lost in waiting, but a 
physician must be immediately summoned. In case his ar- 
rival is delayed certain measures can be adopted with advan- 
tage. 

In actual abortion the pains are not to be interfered with, 
because they are necessary to produce evacuation of the con- 
tents of the womb. The hemorrhage constitutes the danger 
to which the woman is subjected, and certain means, in 
the absence of a physician, may be used either to moderate 
or to check it. The foot posts of the bed upon which the 
patient lies should be raised four or five inches by placing 
bricks or blocks under them. The pillows can be removed 
so that her head may be low. If the flooding be profuse, or 
if it has continued long enough to weaken the patient to any 
great extent, a plug or tampon of cotton batting must be 
used. To apply this properly some of the cotton should be 
firmly rolled into a ball about the size of a goose egg. This 
should be tied to the end of a strong string so as to be easy 
of removal. The patient's hips being placed on a pillow 
and her limbs widely separated, the nurse gently introduces 
the cotton into the vagina with her fingers, and pushes it up 
as high as possible so as to press it against the mouth of the 
womb. Additional pieces of cotton can now be introduced 
and crowded up against the first until the whole canal is 
tightly packed. If there is a tendency to expel the cotton 
by straining, it will be necessary to keep it in position by 
pressing against it with the hand until the physician arrives, 



Pregnancy. 31 

or else it can be confined by a properly constructed bandage 
passed between the limbs and fastened in front and behind 
to a strip that has been placed around the body. The great- 
est gentleness and caution must be observed in following the 
above direction. 

A moderate amount of whiskey, or wine, or other stimu- 
lants, can be given for the purpose of keeping up the patient's 
strength until the arrival of her medical attendant. 



CHAPTER II. 



Honftttemtnt 



PREPARATIONS FOR CONFINEMENT. 

AS the time approaches when a woman expects to be con- 
fined, her attention should be given to making prepara- 
tions for the event. She will need a few extra articles of 
clothing for her own use, and some dressings for the bed 
upon which she is to lie, as well as proper clothes for the 
child. 

The gowns that she is to wear, while in the lying-in state, 
should be made much shorter than her ordinary night gowns, 
as they will answer every purpose of the long ones and w T ili 
be more convenient. 

For the first few days after confinement the bandage can 
be made of a towel or strip of muslin sufficiently long to go 
around the body. It will be necessary to change it very 
often, and hence there is no need, at this period, to use one 
that requires time and labor to construct. But after the 
wasting has in a measure ceased, a well fitting bandage, 
properly made, will be much more comfortable and useful. 
It should be of heavy unbleached muslin, not too coarse,- and 
should be a little over a foot in width, and about a yard and 
a quarter in length, so as to reach around the body. It 
should come well down over the hip bones, and the lower 
edge can be gored, so as to make it a little narrower than it is 
a few inches above. This will prevent any tendency that it 

[32] 



Confinement. 33 

may have to slip upwards. Of course, the upper part of the 
bandage should be narrower, so as to fit the body around the 
lower ribs. 

The bed should consist of a soft mattress, upon which is 
first placed a comfort, and then a sheet. On the right side 
of the bed, where the patient's body will rest, an oil cloth 
should be laid, and over it an old comfort that has been 
twice folded. A sheet, upon which the woman will lie, can 
be laid over the comfort, When labor is completed, the 
sheet, comfort and oil cloth can be removed, leaving the bed 
ready for the patient to rest upon. A few clean napkins 
and towels — those that are well worn are the bes£; a few 
old muslin cloths; some good castile soap; a pair of scis- 
sors; some pins, and some fine tape or thread with which 
to tie the navel-string, should be within easy roach when 
wanted. 

That portion of the child's clothes that are worn next to 
the skin should be made of canton flannel. The petticoats 
ought to be of fine flannel, and no part of the clothes should 
be starched. The diapers must be of fine canton flannel. 

When waiting upon a woman in labor, as well as during 
her lying-in period, the nurse must observe the strictest rules 
of cleanliness. She must thoroughly wash her hands in hot 
water, and clean her finger nails before examining the pa- 
tient, or giving her an injection, or touching her in any 
manner about the birth passages. Under the finger nails 
of a nurse arc often concealed disease-producing germs that, 
on being introduced into the mother's passages, may pro- 
duce a disease of the most fatal character. 

Napkins and bandages that have been soiled by discharges 
from a lying-in woman must be frequently removed and de- 
stroyed or placed in boiling water. 

No person having an old ulcer, or a sore oi' an offensive 
character, should be permitted to enter the room of a lying-in 
3 



34 The Mother's Haxd-Book. 

woman, as septicaemia, or child-bed fever, might result from 
such exposure. Absolute cleanliness on the part of both 
patient and nurse is essential during the whole lying-in pe- 
riod. 

A neglect of these precautions may cost the patient her 
life. 

Labor. — While first labors are probably not more danger- 
ous than subsequent ones, they are generally more protracted 
and severe. It is usually during her first pregnancy that a 
woman makes the mistake of thinking that she is in labor 
and sending for a physician, when, in fact, the labor has not 
commenced. These mistakes arc called " false alarms," and 
are a cause of much embarrassment to a young woman. 

Labor is divided into three stages. The first stage begins 
at the commencement of the pains, and terminates when the 
neck of the womb is thoroughly dilated. 

The second stage begins when the neck of the womb is 
dilated, and ends with the birth of the child. 

The third stage begins with the birth of the child, and ends 
with the expulsion of the after-birth. 

Symptoms of Approaching Labor. — It often happens that a 
day or two before labor begins the woman feels better than 
usual. She seems to be smaller, she breathes easier, and is 
freer from stomach disorders. 

This is owing to the " dropping of the womb, 5 ' so called. 
The womb settles lower down in the pelvic cavity, and hence 
there is less pressure on the stomach, diaphragm and other 
.organs. As it does this it necessarily presses more or less on 
the bladder, and the irritation caused by the pressure usually 
gives rise to irritability of that organ and a frequent desire 
to j)ass water. If this trouble becomes very severe the pa- 
tient should take to her bed, as lying on her back with her 
hips raised will give her some relief. About this time she 
will notice that there is an increase of moisture of the pas- 



Confinement. 35 

sages leading to the womb. This secretion soon becomes 
thick, and consists of mucus streaked with blood. This dis- 
charge must not be confounded with true hemorrhage, which 
may occur at this period and is always a complication that 
requires the immediate attention of a physician. While the 
" show " consists of lumps of mucus streaked with blood, 
hemorrhage always appears as clear fluid blood, or else in 
the form of clots of blood, either dark or red, and unmixed 
with other substances. 

The appearance of the " show " indicates that labor has 
really commenced. 

First Stage of Labor. — About the time the show begins the 
woman feels slight cutting pains, which increase in severity 
and frequency until she is in hard labor. These cutting or 
" grinding " pains come on at uncertain periods, from a half 
hour to two hours apart. 

When the pains are of a cutting or grinding character no 
attempt should be made to aid them by " bearing down." 
This will do no good and will weaken the patient. 

A woman about this time may be seized with shivering, 
which, although it may be sufficient to make her teeth chat- 
ter, is not attended with coldness of the body and is not an 
unfavorable symptom. No spirituous liquor of any kind 
should be given under these circumstances, except by direc- 
tion of a physician, but the patient may take hot tea or 
gruel and have an extra blanket thrown over her. It is ne- 
cessary, however, to be careful in the matter of covering, 
and if she has many covers thrown over her while she has 
an attack of shivering, the extra blankets must be gradually 
removed as she gets warmer. 

To continue the application of too many blankets for a 
long time — thus inducing profuse sweating — would debili- 
tate her at a time when she needs all the strength possible 
for her coming labor. 



3G The Mother's Hand-Book. 

At the beginning, or indeed at any time during labor, 
sickness of the stomach may distress the patient, causing her 
to vomit frequently. However distressing or inconvenient 
this may be, it is not an unfavorable symptom and should 
not be meddled with. Nothing can be taken that will settle 
the stomach, and toddies and other drinks will only add 
to her discomfort. Sickness of the stomach and vomiting 
favor the completion of labor by relaxing the soft parts, thus 
tending to an easier and speedier delivery. 

During the first part of labor, when the pains are grind- 
ing and infrequent, the patient need not confine herself to 
the bed, but may walk about the room or sit in a chair, thus 
consulting her own comfort. 

Second Stage of Labor. — After awhile (the period of time 
differing in different labors) the pains change in character, 
becoming what is known as " bearing-down pains," and are 
more regular and frequent. These are true labor pains, and 
are situated in the back and loins, and are of a dull, deep 
character, lasting longer than the grinding pains. 

If the family physician be within easy reach he need not 
be summoned, in natural cases, until true labor pains begin, 
unless the " waters break" prematurely. Whenever the 
" waters give way" it is necessary to send for medical assis- 
tance, as, in most cases, active labor will begin in a short 
time afterwards. 

In some cases, but rarely, the waters may break and the 
woman go a day or two before labor actually begins. 

Towards the close of labor, cramps of the legs and thighs 
may produce considerable suffering. These cramps are 
caused by the child's head pressing on the nerves that go to 
the limbs. But little can be done for the patient's comfort, 
but occasionally some relief may be had by the patient's 
changing her position, the nurse, meanwhile, firmly rubbing 
the affected part with her warm hand, and making decided 
pressure during the act of rubbing. 



Confinement. 37 

In a natural labor but little assistance is needed, and med- 
dlesomeness and over-anxiety on tbe part of the nurse is to 
be condemned. Tbe physician himself has but little to do 
except toward tbe close of confinement, and even his pres- 
ence in the room is needed only at intervals. Many patients 
think that a doctor, by being constantly present and exam- 
ining them during a pain, can greatly help them and expe- 
dite the labor. This is a mistake as applied to an ordinary 
case. The examinations, after the first, are made only to 
ascertain the progress of the case, and hence need not be fre- 
quent. It is much less embarrassing and annoying to the 
patient if the physician be most of the time in an adjoining 
room within easy call, instead of being constantly at her bed- 
side. After a thorough examination, by means of which he 
recognizes the condition of the patient, the progress of the 
case and the part of the child that presents, he has but little 
to do until towards the close of the labor. 

These remarks apply strictly to natural labor, bearing in 
mind that a labor may be tedious and yet natural. In diffi- 
cult or complicated cases, however, the physician will have 
much to do, and will necessarily be at the side of the patient 
most of the time. Under such circumstances the patient 
should place herself entirety in the hands of her medical at- 
tendant and be guided solely by his advice. The duty of the 
nurse will be to obey the physician, following his directions 
implicitly. The patient is now in danger, and as the physician 
has sole charge of the case and is alone responsible for its 
termination, his orders must be obeyed without protest, lie 
must have the confidence and support of the patient and 
nurse, as such confidence will tend to strengthen li is judgment 
and nerve his hand to the performance of those acts that are 
necessary to guard the lives of both mother and child. It will 
be fortunate indeed if he be a man of much knowledge, cor- 
rect judgment and great skill, with a stout hearl and decision 



38 The Mother's Hand-Book. 

of character. It will be his duty to detect any change in 
the progress of the labor which renders it difficult or dan- 
gerous; to determine whether nature, if left alone, will bring 
the case to a safe issue, or whether it is necessary to assist 
the natural process by artificial means. And in those cases 
where nature unaided is powerless to complete the labor, 
and the resources of art must be brought to her aid, he must 
act promptly and with precision. In some cases moments 
are precious, and if not properly utilized the lives of two 
beings may y&y the penalty. 

A woman that is confined for the first time, after being 
somewhat advanced in life, will likety have a more lingering 
and painful labor than she would if she were younger; but 
her subsequent labors may be as easy and speedy as if she 
had begun child bearing at an earlier age. 

Slow labors may not be dangerous ones ; indeed, they are 
much safer than abnormally quick ones. In the latter the 
shock is often great, while hemorrhage after delivery is 
especially liable to occur in labors that are too speedily ter- 
minated. 

During the second stage of labor the patient can mate- 
rially aid in the expulsion of the child by " taking a breath " 
and gently bearing down with her pains. She can brace her 
feet against a box, or the foot-board, and grasp the hands of 
an attendant. " Bearing down " with the pains will not in- 
crease her suffering and will greatly assist in expelling the 
child. Towards the close of labor the pain becomes so 
severe that the patient will frequently utter loud cries with 
her pain, and no one should direct her to refrain from such 
cries, as they really seem to give her some relief. She should 
bear down only when the pain is on her, and cease doing so 
when it goes off. If, during the last two or three pains, the 
head of the child is passing too rapidly (before the soft parts 
of the mother are properly relaxed), there is danger that 



Confinement. 39 

those parts may be torn or lacerated, and the physician 
should direct her not to bear down under such circumstances. 
This injunction the mother must strictly comply with, in 
order to avoid serious injury and much subsequent suffering. 

The position in which women are placed during labor va- 
ries in different countries. In this country they usually lie 
on the back, which is the most convenient for the attendants 
and perhaps best for the patient. 

Attention must be paid to the bowels, and if they are at 
all inclined to constipation an injection should be used as 
soon as labor is threatened. The bladder must be kept 
empty, a catheter being used for that purpose if necessary. 
Usually, however, the urine comes from the patient in small 
quantities and at frequent intervals. 

Towards the close of labor, when the pains are severe and 
long continued (and the head of the child is pressing against 
the mother's soft parts), the nurse can take a folded napkin 
and place it against the mother just below the opening of the 
passage that leads to the womb, and with the palm of the 
hand make gentle, steady pressure directed slightly upwards. 
This gives support to the mother and tends in some degree 
to prevent the tearing of her soft parts. 

If no physician be present at the 'time of the confinement, it 
becomes necessary that the nurse, or some attendant, should 
have a clear conception of what should be clone and what 
should not be done. 

The nurse and attendants should understand that in most 
cases of labor there is but little danger to the mother if na- 
ture be left to herself to complete the delivery. Knowing 
this fact they will be cheerful, calm and hopeful. They 
should by their actions and conversation inspire the mother 
with confidence in a safe delivery. No allusion should be 
made to cases of tedious, difficult, or fatal labors. The 
mother on her part should banish all fears o( danger and 



40 The Mother's Hand-Book. 

compose her mind in the firm belief that she will go through 
the ordeal in perfect safety. 

When the bearing down pains become strong the patient 
should take to her bed, haying previously arranged her 
clothing for her confinement, and after taking hold of the 
hands of an assistant, she will bear down when the pain is 
on, and cease to do so when it goes off. 

When the head of the child emerges through the mother's 
jmssages, the nurse should feel for its neck, and if the cord 
be wrapped around it, she will gently slip it over the child's 
head. The pains continuing, the shoulders will soon be 
found ready to pass through the external parts. The pres- 
sure with the napkin should be kept up at this stage, as the 
passage of the child's -shoulders not infrequently produces 
laceration of the mother's soft parts. 

When the shoulders are born the nurse should take hold of 
the child, and without pulling on it at all, raise its head and 
shoulders upwards an<J forwards until they nearly touch the 
mother's abdomen. By this time the hips will be born, and 
the child €&n then be taken away from the mother and 
placed on the bed between her limbs. 

Directions for the subsequent management of the child 
will be found in the next chapter. 

Third Stagv- of Labor. — If there is much hemorrhage soon 
after the birth of the child, the nurse should place her hand 
oyer the?- mother's womb and make gentle but continuous 
pressure oyer that organ. The pressure should be directed 
backward and slightly downward, the purpose being to 
bring on contraction of the womb (for a contracted womb 
rarely bleeds much after delivery), thus aiding the expulsion 
of the after-birth. Care must be taken not to make this pres- 
sure firm enough to give pain to the patient; but it should 
be kept up until the womb is felt under the hand as a hard, 
round, well-contracted body. 



Confinement. 41 

If, in spite of these efforts, the mother continues to lose a 
great amount of blood, it will be necessary to remove the 
after-birth at once in a manner hereafter described; but con- 
tinued efforts must be made to keep the womb well contracted 
by making gentle, firm pressure over it with the palm of the 
hand. In addition to these measures it will be best to take 
the pillows from under the patient's head, and raise the foot 
of the bed with bricks or blocks, placed under the posts, the 
object being to keep her head lower than her body. When 
flooding occurs after the after-birth has come away, it may 
be necessaiy to apply cloths wrung out of cold water (ice 
water preferred) over the womb, and in severe cases, if ice 
be handy, a piece, the size of a walnut, can be placed up the 
external passages, in contact with the mouth of the womb. 
All these things can be done with safety by an intelligent 
nurse, and the physician (who should be sent for as soon as 
it is found that the mother is in danger from flooding) will, 
on his arrival, find that the nurse has pursued the best course 
possible for the patient's safety. 

In the course of a few minutes, or a half hour after de- 
livery, the patient will be seized with after-pains, and if no 
physician is expected, it will be the duty of the attendant, 
in some cases, to aid nature in expelling the after-birth. 
Usually this should not be attempted until at least a half 
hour has expired after the birth of the child, and not until 
the patient has had one or two after-pains. After having 
waited a proper time, the attendant, on finding that a pain is 
commencing, takes hold of the cord and wraps it around the 
first two fingers of the left hand close to the mother's body, 
and then inserting the first two fingers of the right hand, 
well oiled, into the mother's passages, gently pushes them 
up to where the cord is attached to the after-birth, and then 
with the points of the fingers makes gentle pressure down- 
ward and backward on the cord at, or near, its attach- 



42 The Mother's Hand-Book. 

ment; or, if the fingers come in contact with the after-birth, 
the pressure should be made on that body. While the nurse 
is making pressure on the cord, or the after-birth, with the 
fingers of the right hand, she should also, with the left, 
make gentle traction downwards on the cord to aid nature in 
expelling the after-birth. In these manipulations the nurse 
must exercise the greatest caution not to tear the cord loose 
from its attachment. The traction should be gently and 
slowly made, and if an impression is communicated to the 
nurse's hand, as if the cord is about to become separated 
from the placenta, she must cease all traction upon it at once 
and wait until a physician arrives. These efforts to aid na- 
ture in expelling the after-birth must cease when the pain 
goes off, to be repeated, if necessary, when another seizes 
the patient. If, after assisting nature in this manner dur- 
ing one or two pains, the after-birth does not come away, it 
will be best to let the patient alone until a physician can be 
had to take charge of the case. The attendant must bear 
in mind that no rough handling of the patient is allowable, 
as her life may thereby be greatly imperiled. 

As before stated, if a physician is expected within a rea- 
sonable time after the birth of the child, the attendant will 
content herself, so far as the mother is concerned, by tying 
the cord and making gentle pressure over the womb. 

After the expulsion of the after-birth, it will be proper to 
dip a folded napkin into hot water, wring it as dry as possi- 
ble and then sprinkle dilute alcohol, or Avhiskey, or spirits of 
camphor, upon it and lay it against the mother's external 
parts. Then a bandage, consisting of a wide towel or mus- 
lin folded, should be closely pinned around the mother's ab- 
domen, after which the clothing on the bed must be changed. 
A dry, warm comfort, over which a sheet can be placed, must 
be put under the patient, and she should be left to rest, and, 
if possible, to secure a good sleep. 



Confinement. 43 

At the beginning of labor, the patient's clothing should 
be drawn up around her chest and shoulders, and a large 
loose skirt, or folded blanket pinned around her waist, 
which, after labor is completed, may be taken off, and the 
clothing pulled down and nicely adjusted around her body. 
By proceeding in this manner it will be unnecessary to dress 
the patient soon after labor; a proceeding that is always fa- 
tiguing and sometimes dangerous. 

After-pains, as a rule, do not follow a first labor, but in 
subsequent ones they are often annoying and persistent. They 
are necessary after all labors except the first, and are caused 
by contraction of the womb to expel clots of blood. They may 
become so annoying as to require treatment for their modera- 
tion, and the physician should be consulted when they are 
very severe or too long continued. When medical advice 
cannot be obtained, the nurse may apply flannels wrung out 
of hot water, and give some warm aromatic drink, as an in- 
fusion of ginger, or possibly a dessertspoonful of Godfrey's 
Cordial. If the patient, on the second or third day after 
labor, takes a dose of castor oil, or other purgative, the clots 
which produce the after-pains will usually be expelled while 
the patient is on the vessel evacuating her bowels, after 
which the pains will cease. 

It not infrequently happens that the perineum of a mother 
is torn or ruptured during the passage of the child's head 
or shoulders through her soft parts. The laceration may 
consist merely of a slight tear of the skin and cellular tis- 
sue, or it may involve all the structures between the vagina 
and the bowel, constituting complete rupture. In severe 
cases, the physician will, as a rule, make an attempt \o re- 
pair the injury by drawing the parts together and confining 
them in position by inserting suitable stitches. The opera- 
tion, however, is not always successful, and in many cases 
it is necessary to repeat it after the patient has recovered 
from the effects of her confinement, 



44 The Mother's Hand-Book. 

If the laceration has been slight, and does not involve the 
bowel, the injury is usually repaired by natural means, aided 
by proper position and good nursing. In such cases the 
patient's limbs must not be permitted to become widely 
separated, and to prevent this a bandage should be placed 
around the hips and thighs, and securely fastened. One of 
the dangers to be feared from rupture of the perineum, even 
when the injury is slight, is septicaemia, or blood-poisoning. 
When arising from this cause, the disease, although usually 
of a mild form and not dangerous to life, is sufficient to 
cause the patient a great deal of pain and suffering, and to 
interfere materially with her recovery from the lying-in state. 
To prevent the occurrence of septicaemia, which in these 
cases is produced by absorption of septic and decomposed 
matters at the point of injury, it is necessary to keep the 
injured parts as clean as possible by frequently washing 
them with warm water and afterwards bathing them with 
dilute alcohol. If the wasting from the womb be offensive 
and irritating, it will be necessary, once or twice a day, to 
carefully inject into the vagina enough warm water to wash 
away the irritating matters. If the bowels are at all consti- 
pated, they should be gently moved by the use of some pur- 
gative that will produce loose, watery evacuations. For this 
purpose Epsom salts, Tarrant's Seltzer, or a Seidlitz powder 
will be proper. 

After confinement the patient should be provided with a 
pleasant, well ventilated room. The air in the room ought 
to be comfortable, but not too warm, and sudden changes of 
temperature should be guarded against. In the winter-time, 
doors communicating with the outside air must be kept 
closed and ventilation should be secured by slightly drop- 
ping a window, or by openings leading into other rooms. 

As before stated, when the after-pains are very severe, it 
may be necessary to give medicine to moderate them. 



Confinement. 45 

On the second or third day after confinement it is the cus- 
tom in many places to give a dose of castor oil to move the 
bowels. This medicine is very certain in its action, and is 
usually safe as well as efficient. But if the patient be 
affected with piles, it is best not to give the castor oil, as it 
will often increase the suffering from the hemorrhoids. In 
such cases the nurse can administer a dose of syrup of rhu- 
barb, to which a teaspoonful of Epsom salts (previously dis- 
solved in a little hot water) has been added. A Seidlitz 
powder, or a dose of Seltzer's Aperient can be substituted if 
the patient prefers it. 

The diet of a lying-in woman should be nutritious and 
given in sufficient quantities. If a patient is doing well and 
is without fever, it is not necessary to restrict her diet to 
slops and such articles as are usually given to sick people. 
She should have as good food as she has appetite for and 
can easily digest and assimilate. The nurse should see that 
the patient passes water as often as every eight hours. 
Sometimes, after confinement, a woman does not feel the 
ordinary sensations that attend upon a distended bladder? 
and if let alone she will j^crmit the bladder to become so 
enormously distended that it loses its power of emptying 
itself. If there be much trouble in passing water, which is 
sometimes the case, the nurse should direct the patient to 
turn on her face and knees, when she will likely succeed. 
She must not, however, exhaust herself by vain efforts to 
empty the bladder ; but if the distention be great, and the 
patient unable to urinate, a physician must be summoned to 
draw off the urine with a catheter. 

Sometimes, a day or two after labor, severe pains are ex- 
cited by the presence of gas in tjhe bowels. In such eases 
the abdomen is greatly distended, and very slight pressure 
with the hand causes an increase of the pains, while linn 
pressure gives relief. This condition is best treated by bath- 



46 The Mother's Hand-Book. 

ing the abdomen with a mixture of turpentine and lard, 
after which cloths wrung out of hot water can be applied. 

The lochia is the discharge that takes place from the birth- 
passages after confinement. At first it consists principally 
of blood that oozes from the blood vessels of the womb. It 
afterwards becomes greenish yellow, and lastly thin and 
watery. During the first twenty-four hours the discharge is 
profuse, becoming less in quantity on the second day, and 
gradually decreasing until it ceases. The duration of the 
lochia varies, sometimes continuing for weeks in the form of 
a Avatery discharge. Occasionally it ceases temporarily when 
the milk comes into the breast. Usually it will, however, 
soon re-appear, and need not give rise to any alarm or anxiety. 
In the absence of fever and inflammation, the cessation of 
the discharge at an early day is not an indication of danger. 

An extremely offensive discharge may be caused by the 
decomposition of clots of blood in the womb. In such cases 
an injection of warm water into the vagina should be made 
io wash away the offensive matter. The injection should be 
carefully made, and too much force must not be used in 
throwing the water into the passages. Sometimes the addi- 
tion of a little alcohol or whiskey to the water is useful. 

In very rare cases, owing to a variety of causes, flooding 
may take place within a few days after confinement. If pro- 
fuse, these hemorrhages are dangerous, and medical assist- 
ance must be obtained without delay. Before the physician 
arrives the nurse should raise the foot-posts of the bed and 
remove the pillows from under the patient's head. She 
should also take a large piece of muslin, fold it into a 
compress about eight inches square, and dip it into very 
cold water — ice water, if it be at hand — then, squeezing part 
of the water out of it, lay it on the lower part of the abdomen 
over the womb. This should be held in position by a band- 
age placed around the abdomen and firmly pinned in front. 



Confinement. 47 

The length of time that a woman should be confined to 
her bed after delivery varies according to circumstances. A 
healthy woman who has had no trouble during or after 
confinement may sit up in eight or nine days after the birth 
of her child. If she be weak, and if her previous health 
has not been good, she had better remain in bed for a week 
longer. During the period of her confinement to the bed 
she should change her position frequently. To lie constantly 
on the back, or in any other one position, invites displace- 
ments of the womb. That organ now being large and heavy, 
and its supports being weak and lacking their natural con- 
tractile power, it is unwise to permit it to remain too long 
in any one position. After a few hours' rest on her back, the 
patient can change first to one side and then to the other, 
and occasionally she should lie in a position midway between 
the side and abdomen. By pursuing this course she will 
not be as liable to suffer from " falling of the womb " after 
delivery as would be the case if she were to lie too long at a 
time in one position. 

A woman who has had previous labors, and who has suf- 
fered from falling or other displacement of the womb, must 
remain in bed a much longer time. By doing so, and by 
placing herself under the treatment of a skillful physician 
during her lying-in period, she can usually be cured of her 
uterine trouble. In such cases the length of time that she 
should remain in bed will depend upon the severity of her 
disease, and must be settled by her medical attendant. 

When a woman insists on getting up before the womb has 
been reduced in size and weight, and before the ligaments 
and supports that keep it in place have returned to their 
normal condition of strength, she only invites an attack 
of some form of womb trouble that may afflict her during 
her lifetime, rendering her existence miserable in the ex- 
treme. 



48 The Mother's Haxd-Book. 

Sore Nipples. — This is a somewhat frequent and painful 
affection, to which lying-in women are subject. There are 
different varieties of it, requiring, to some extent, different 
kinds of treatment. 

In excoriations of the nipple, the outer layer of skin is 
removed by nursing, leaving the nipple of a light red color, 
swollen and fissured. Scabs may form, which are pulled off 
by the child, producing a chapped or ulcerated condition of 
the part. Sometimes the ulceration continues until half the 
nipple is destroyed. Under such circumstances the act of 
sucking is attended with excruciating pain. 

After each nursing the nipple should be carefully washed 
with warm water, dried, and then painted with the com- 
pound tincture of benzoin. If the part be very sore, a nip- 
ple shield must be used, through which the child may draw 
the milk. 

If considerable ulceration exists the child must be taken 
from the affected breast for a few days until measures can 
be taken to cure the disease. The breasts can sometimes be 
kept sufficiently freed of milk by applying warm sweet oil, 
and then, with the hand, gently rubbing them from the cir- 
cumference toward the nipple. This requires patience and 
a little time. If the milk cannot be removed in this man- 
ner, a breast pump, with a large mouth, which will not 
press on the nipple, can be applied often enough to relieve 
the over-distended breast. The chapped or ulcerated parts 
should be frequently dusted with calomel. 

At the base of the nipple there is sometimes a crack or 
fissure which may be very small, and yet cause the 
greatest suffering when the child nurses. The compound 
tincture of benzoin should be applied to it several times a 
day; and if it does not heal under this treatment, it may 
be necessary once a day to touch it gently with lunar 
caustic. 



Confinement. 49 

Occasionally these affections of the nipple give rise to in- 
flammation and abscess of the breast, one of the most 
painful and protracted complaints that afflict the lying-in 
woman. 

Abscess of the breast is most liable to occur during the first 
four weeks after confinement, but it may happen at any time 
during nursing. In very rare cases an abscess may form in 
the breast before confinement, and under these circumstances 
it constitutes a very serious complication of the pregnant 
state. Under the excessive pain and drain upon the sys- 
tem, the patient rapidly loses flesh, becomes exhausted, and 
is in no proper condition to undergo the pain and confine- 
ment incident to child-birth. 

The causes that may produce abscess of the breast are: ex- 
posure to cold; inflammation of the nipple, extending to the 
breasts; a sudden stoppage of the secretion of milk at an 
early date; obstruction of the milk ducts; various injuries, 
and possibly shock to the nervous system from fright, etc. 

There are three varieties of abscess of the breast, depend- 
ing upon the situation of the disease. 

In the first form, the disease is situated in the tissue above 
the milk-gland, and under the skin; in the second, the milk- 
gland itself is the seat of the trouble; and in the third form, 
the disease is situated below the gland, and between it and 
the walls of the chest. 

In the first form, which is the simplest, the disease is 
not deep-seated, and hence recovery takes place much 
sooner than when the gland, or the tissues below it, are af- 
fected. Ordinarily the abscess is ready to be opened in 
eight or ten days from the beginning of the attack, after 
which the parts soon heal. 

In the second, or glandular form, the disease runs a more 
protracted course; one lobule after another beeomes inflamed, 
producing abscesses in different parts of the breast. Owing 



50 The Mother's Hand-Book. 

to the number of abscesses that usually form in this variety, 
the disease may last from one to three months. 

In the third form, where the disease is deep-seated, being 
below the milk-gland, the condition of the diseased struc- 
tures is hard to determine until suppuration has taken place. 
The matter is not limited to a small space, as in the first 
form, but is scattered over a considerable area. If not evacu- 
ated by the knife, it slowly finds its way to the surface by 
different channels, causing, in some cases, fistula? which are 
hard to heal. In many cases of this kind, recovery will not 
take place for two or three months after the beginning of 
the disease. 

In abscess of the breast, where the milk-ducts are involved 
in the ulcerative process or have been divided by the knife, 
the matter will be mixed with milk, and the milk may con- 
tinue to flow from the openings even after the matter has 
ceased. 

Treatment. — Abscess of the breast is such a painful and 
protracted disease that a physician should be called in every 
case. The nurse, however, by being properly instructed, 
can add much to the patient's comfort, as well as aid mate- 
rially in her recovery. In the very earliest stage of the first 
(or superficial) form of abscess — say, twenty-four hours from 
the beginning — the application of tincture of iodine to the 
skin, over the seat of inflammation, may prevent the forma- 
tion of matter. After the inflammation has advanced, how- 
ever, beyond the first day, the iodine will likely do no good. 
For the relief of pain and over-distention of the vessels of 
the breast, a warm, moist poultice (not too heavy) should be 
used. The flaxseed meal, or slippery elm poultice is per- 
haps the best. It should be re-applied often and be kept 
warm and moist. If preferred, cloths wrung out of hot 
water may be used in place of the poultice. There must be 
no rubbing of the breasts with salves or liniments, as such 



Confinement. 51 

treatment would do no good and would increase the inflam- 
mation. As soon as matter lias formed, it should not be 
allowed to ulcerate through the skin and open spontaneously, 
but, as early as possible, the knife should bo used, so as to 
thoroughly empty the abscess. 

In the second, or glandular form of the disease, the milk 
ducts are usually engorged and obstructed. The child 
should be taken from the mother, and if the breast contains 
too much milk, giving rise to over-clistention and pain, it 
can be emptied by applying warm sweet oil and gently rub- 
bing it from the circumference towards the nipple. If the 
milk is not easily pressed out of the breast in this manner, 
the application, for a few minutes, of cloths wrung out of hot 
water will usually overcome the difficulty. 

In the third, or deep-seated form of the disease, there must 
be no rubbing of the breast or other interference that may 
cause pain or increase the inflammation. The nurse can do 
but little in this variety of abscess, except that by the appli- 
cation of cloths wrung out of hot water, she may aid in re- 
lieving pain to some extent until the arrival of a physician, 
whose presence will relieve her of further responsibility. 

The medicines and operative procedures required in the 
management of abscess of the breast have not been alluded 
to, for the reason that they are matters that belong solely to 
the jurisdiction of the physician, and can be of but little in- 
terest to the mother or nurse, for whose benefit this book is 
written. 

Milk Fever. — The secretion of milk is not, ordinarily, at- 
tended with any appreciable fever. Sometimes, however, 
in about forty-eight hours after confinement, a woman may 
be attacked with milk fever, or, as it is often called, "the 
weed." 

The disease usually lasts from twenty-four to forty-eight 
hours, when the fever subsides and the patient becomes con- 



52 The Mother's Hand-Book. 

valescent unless there is some inflammatory complication. 
If it continues for three or four days (which is sometimes 
the case) the probabilities are that it is attended with inflam- 
mation of some organ, or else that there is a malarial element 
present, which will require the administration of quinine for 
its cure. 

The symptoms of milk fever are headache, a flushed face, 
a furred tongue, thirst and loss of appetite, heat and dryness 
of the skin, and a swollen and tender breast. The attack is 
often ushered in by slight shiverings, and after it is fully 
developed the skin loses its dry character and becomes bathed 
in a profuse perspiration. During an attack of milk fever, 
the flow, or lochia, may be diminished in quantity, or cease 
altogether, for a few hours, after which it returns in its-usual 
quantity. 

In the treatment of milk-fever, attention should be given 
to the bowels, and if they have not been freely moved, a 
dose of Epsom salts, or Tarrant's Seltzer powder can be given. 
A teaspoonful of sweet spirits of nitre, in a half wineglass 
of water, every two hours will moderate the severity of the 
fever. 

If the patient is sleepless, or if the nervous irritability is 
great, a dose of Dover's powder may be given to produce 
rest and a quiet sleep. 

The breasts should be gently rubbed, from the circum- 
ference towards the nipple, with warm sweet oil every two 
or three hours until the pain and distention have subsided. 
They should also be sufficiently emptied by being drawn 
either by the child or by a breast-pump. 

In cases ivhere the child is still-born, or dies before it has 
been put to the breast, the milk should be dried up as soon 
as possible. This is best accomplished by refraining from 
all attempts to empty the breasts. No matter how swollen 
or painful they may be, if no efforts are made to draw the 



Confinement. 53 

milk from them, the swelling and tenderness will subside 
in a few days without the formation of an abscess. 

As the breasts become swollen and tender, they should be 
gently bathed with warm sweet oil — taking care not to rub 
them — after which they can be covered with warm cotton 
batting. 

The patient should, at the same time, drink but little, and 
the food should be of a light character and partaken of in 
small quantities. 

Constipation must be overcome by mild laxatives, such as 
Epsom salts, or Tarrant's Seltzer powder. 



CHAPTER III. 



attention to the CltU& soon after JSirtiv 



AFTER the child has been born and its connection with 
its mother has been severed by tying and cutting the 
cord, it should be carefully handed to the nurse, who will 
proceed to wash and dress it. 

If no physician be present, the nurse will have to give 
attention to both mother and child; and to aid her in doing 
so, the following directions are given: 

As soon as the child has passed from its mother the nurse 
will place it in a comfortable position in the bed, between 
the mother's limbs if she be lying on her back. The infant 
should then be carefully examined, and if the cord be around 
its neck it should be slipped gently and carefully over its 
head, to enable it to breathe without difficulty. Sometimes 
the cord is so short that it cannot be passed over the child's 
head without tearing it loose either from the child or the 
after-birth. In such cases the nurse will take hold of it at 
some convenient place, raise it up, and putting a strong 
string or small tape around it in two places, an inch apart, 
tie it tightly and divide it half way between the knots. If 
at this time the cord is tied and divided in this manner, it 
will be unnecessary to tie it again before dressing the in- 
fant. About two inches from the child's body is the proper 
place to tie the cord, unless at that point there is a bleb or 
blister, in which case the ligature should be placed further 
from the abdomen. 

[54] 



Attention to the Child soon after Birth. 55 

Small tape is very convenient for tying the cord; but if 
none can be had, a ligature can be made by taking six or 
eight strands of No. 20 spool thread, which should be twisted 
hard and then doubled; or, if the thread is not convenient, 
twine, such as is used in tying small store-packages, will do. 
This, after being twisted and doubled, will be large enough 
to prevent any cutting into the tissues. The ligature should 
be drawn as tight as can well be done by the fingers. 

Occasionally the child, when born, is of a bluish or livid 
color, owing to a deficiency of air in its lungs. In such 
cases free exposure of its mouth to the air and sprinkling a 
few drops of cold water on its face will usually aid in re- 
storing its lungs to a healthy action. In some severe cases 
it is necessary to temporarily remove the ligature from the 
cord, so that it may bleed; but this should be done only by 
a physician. 

After the cord has been properly tied and cut, the child 
should be enveloped in a soft blanket, or other suitable ar- 
ticle, and given to the nurse with directions to wash it. 

Attention should be paid to the cut surface of the cord, 
and if it be bleeding it must be again tied by placing the 
ligature a little nearer the child's body than before. 

Sometimes a child is born with its throat filled with mucus 
that interferes with respiration, causing the mother a great 
deal of anxiety. The nurse can, by inserting a finger care- 
fully and quickly into the child's mouth, well back, remove 
any loose shreds of mucus that may be in the throat. In 
addition to this the child should swallow a teaspoonful of 
tepid water to which a little sugar has been added. The 
water, when swallowed, will likely take any remaining mucus 
with it into the stomach, thus relieving the child's breath- 
ing. 

Children are sometimes born with what is known as ei/a- 
nosis, or blue disease. Not only are they livid at the time of 



56 The Mother's Hand-Book. 

their birth, but this condition keeps up for a long time after- 
wards. Usually the color of the skin varies, sometimes be- 
ing dark and at others clearing up to a certain extent, the 
child becoming more natural in appearance. 

This is a grave disease, and most children who suffer from 
it die soon afterbirth. A few, however, recover, and recov- 
ery can be aided to some extent by judicious management. 
The disease is due to non-closure of the opening between the 
two sides of the heart, thus letting the dark blood from the 
right side flow into. the left side before it has been carried to 
the lungs and oxidized, or made red. 

In all such cases the nurse should be instructed to lay the 
child on its right side and keep it in that position. If it can 
be kept alive for several days, there is a chance that the 
opening between the two sides of the heart may be closed, 
after which there will be no further trouble. When death 
occurs in these cases, it is owing to the poisoning of the 
brain and nervous system by the impure blood; and the 
end is preceded by convulsions. 

The nurse, having carefully examined the child's body to 
see that no malformations exist, will proceed at once to wash 
it. In doing this, water at blood heat, and a very soft 
sponge, or a soft, well-worn muslin rag, should be used. A 
lather made of castile soap and warm soft water should be 
applied over a part of the child's body, and after being 
gently rubbed in, it should be removed with a soft rag 
dipped in warm water. The part thus cleansed must be 
thoroughly dried and covered before exposing another part 
of the child. 

The child has not been used to being in contact with the 
air, and the evaporation going on from a wet surface, in a 
room much cooler than the mother's body, may produce se- 
rious results. Indeed, much of the discomfort and sickness 
in infants, soon after birth, is due to the injudicious and cruel 



Attention to the Child soon after Birth. 57 

methods adopted at the first washing. The room must be warm, 
with no current of air passing through it, and But a small 
part of the body must be exposed at one time. 

Sometimes a great part of the infant's body is covered 
with a slippery, cheesy matter that is very hard to remove. 
In such cases it will be well to apply a small portion of fresh 
lard to the part so covered, and, after rubbing it well with 
the fingers, use the lather with a soft rag or sponge to gently 
wash it away. A little patience, and a great deal of gentle- 
ness and care in manipulations, will enable the nurse to 
cleanse the body without irritating the child's tender skin. 

The washing should be done quickly, so that the child 
can be clothed without delay; and under no circumstances 
should it be allowed to become even chilled. If there be 
much cheesy matter adhering closely to the skin, it may be 
best to remove a part only, leaving the remainder to be 
dealt with at a subsequent washing. Protracted washing, 
or harsh rubbing, of an infant's tender skin must not be 
permitted. 

The dressing of a young infant should be conducted with 
a great deal of gentleness and care; and while sufficient 
time must be taken to see that the clothing is properly ad- 
justed, and is not too tight at any point, the operation 
should be completed as soon as possible. 

To dress the cord, take a piece of well-worn muslin, or linen, 
about four inches square; cut a hole in the centre large 
enough to admit the cord. Then pass the cord through the 
opening in the centre and turn it up towards the child's face. 
This will leave the upper half of the muslin under the cord 
and the lower half below it. Now fold the lower half upwards ; 
then turn the two thicknesses that lay to the right of the 
cord over and upon it; then do the same with the two thick- 
nesses that lay to the left. In this manner the cord will be 
neatly enveloped in the soft muslin cloth — one thickness 



58 The Mother's Hand-Book. 

being between it and the child's body, and the other thick- 
nesses on the top. The cord now lying on the child's body, 
in an upward direction, is confined there by the belly-band, 
which is placed over it, and fastened on the back of the 
child. Some nurses will insist on burning a hole in the rag 
through which the cord is passed. Such procedure is use- 
less; but as it is as good as cutting the hole, no objection 
need be raised to the indulgence of such whims. 

The belly-band should be of soft canton-flannel, about 
eighteen inches long and three or four inches wide, and 
must be applied loose enough to permit the nurse to insert 
two or three fingers under it with ease, so as to allow for the 
subsequent swelling of the bowels. 

I have seen cases where the belly-band was applied so 
tight that upon its removal two or three days after the first 
dressing, there was a depression the size and shape of the 
constricting belly-band. 

After the belly-band has been properly adjusted, the nurse 
will proceed to clothe the child. Before dressing it she 
should carefully examine all its parts for deformities, and 
if she supposes any to exist, it is her duty to promptly in- 
form the physician. 

The clothing must be loose at all points, and that which 
is applied next to the skin must be of soft warm material. 
For this purpose a good article of canton-flannel is perhaps 
the best. 

In cold weather the outer garments can be made of fine 
woollen flannel. 

After the child has been dressed it should be laid upon a 
soft pillow and allowed to sleep, to enable it to recover from 
its fatigue. It will often sleep for several hours, and in this 
it ought not to be disturbed. If it cries to any considerable 
extent, an examination should be made to ascertain if any 
pins be sticking it, or if the clothing be too tight at any 






Attention to the Child soon after Birth. 59 

point. If nothing wrong is detected, it will be best to put 
it to the mother's breast in order that it may draw from it 
some of the thin secretion that is usually found there soon 
after child-birth. An early application to the breast is bene- 
ficial to both mother and child. In women who have pre- 
viously borne children, it may cause an increase of after- 
pains, but such pains are necessary to expel clots from the 
womb. The child should not be permitted to take the breast 
too often if there is not much milk in it, as needless sucking 
may produce soreness of the nipples, attended with much 
pain and suffering. 

The early application of the child to the breast will also 
hasten the secretion of the milk, while the thin fluid that 
already exists in it will act beneficially as a purgative upon 
the child. It is just at this stage of infantile life that the 
foundation is often laid for much subsequent suffering and 
danger. The temptation to feed the baby with some of the 
abominable teas and compounds recommended by meddle- 
some persons seems impossible to overcome. In the early 
periods of infancy the child usually needs nothing but what 
is contained in its mother's breast. In fact, it is able to 
digest but little else, and, when through ignorance, its deli- 
cate stomach is crowded with other articles, the innocent 
babe will pay dearly for the officiousness of the nurse. Colic 
soon follows as the result of early over-feeding and dosing, 
the child being doomed to days and months of suffering. 

On a par with injudicious early feeding is the barbarous 
custom of dosing the infant with drugs. I have known 
nurses, on their own responsibility, to administer to new- 
born babes laudanum, soothing syrup, paregoric, sweet oil, 
castor oil, spirits of camphor, and similar articles. Many 
infants succumb to such treatment, and the wonder is that 
so few are destroyed by these drugs when ignorantly given. 
When it is possible to consult a physician no medicines 



60 The Mother's Hand-Book. 

should be given except upon his recommendation. Al- 
though cases do occur where an active drug is indicated, 
yet they are extremely rare, and the rule should be estab- 
lished, seldom to be departed from by the nurse, to give very 
young infants no medicines of a perturbating character. If 
the child seems to be suffering greatly, as manifested by 
long-continued spells of crying, a careful, intelligent physi- 
cian will usually be able to detect the cause and relieve the 
child without resorting to the use of dangerous medicines. 

The child should not be put to the breast oftener than 
every two hours during the day, and at night it will not be 
necessary to give it the breast oftener than every three or 
four hours. Too frequent nursing is particularly injurious 
to the mother, depriving her of needed rest and producing 
nervous exhaustion. It will be well to dry the nipple with 
a soft cloth after each nursing, and the child's mouth should 
be well washed several times a day with tepid water, to 
which has been added a small quantity of alcohol. If these 
measures be neglected, the nipples will likely become sore 
and painful, and the child will be liable to that troublesome 
disease known as thrush. It is not probable that a nursing 
child would ever suffer from thrush if careful attention were 
paid to the washing of its mouth and of the mother's nipples. 

It sometimes happens, however, that for two or three days 
after child-birth there is no milk in the mother's breast. In 
such cases it will be necessary to give the infant some arti- 
ficial nourishment. No artificial food should ever be given 
to a child inside of twelve hours after birth, and, indeed, it 
would in most cases be better to wait for twenty-four hours 
before feeding it. 

The stomach of the infant is weak and unable to digest 
artificial food, and anything of the kind given it too soon 
after birth will cause pain and sickness. But if the mother's 
breast contains no fluid whatever within one or two clays 



Attention to the Child soon after Birth. 61 

after child-birth, it will then be necessary to prepare some 
artificial nourishment for the child. 

The proper kind of artificial food to give a new-born child, 
and the method of its administration, is treated of in the ar- 
ticle on " Feeding," to which the reader is referred. 

As soon as the mother's breasts contain milk, the artificial 
diet must be withdrawn and the child placed to the breast. 
In feeding infants artificially a nursing bottle should be used. 
It is natural for the child to suck, and after sucking the bot- 
tle a few days, it will take the mother's nipple better than it 
would if previously fed with a spoon. It is best to dispense 
with the long tubes and use a bottle with a nipple fixed on a 
short neck. But if a bottle with a long tube is used, the 
tube as well as the bottle must be soaked in strong soda 
water, and afterwards thoroughly rinsed in clear warm 
water as soon as the child has had its meal. 

Still-bom Children. — A child may be born apparently dead 
(still-born), requiring immediate and active efforts to estab- 
lish respiration. It may also be suffering from certain inju- 
ries, the result of difficult and protracted labors. If a phy- 
sician be not present, the nurse should do all in her power 
to relieve the little sufferer. A child that is still-born gives 
but little signs of life at birth, and to a common observer 
it appears to be quite dead. If, however, it be really alive, or 
in a condition to be restored to life, the heart will be found 
beating, although most likely so feebly that none but a medi- 
cal man can detect the heart throbs. 

Therefore the nurse, in the absence of a physician, should 
act upon the presumption that every child born at or near 
full term, even if badly asphyxiated, can, unless signs of 
decomposition are present, be restored to life if proper mea- 
sures are promptly taken to bring about such a result. The 
cord should be carefully examined, and if there be no pulsa- 
tion, or beating, felt in it, the nurse should at once tie and di- 



62 The Mother's Hand-Book. 

vide it in the manner heretofore described. She should then 
take the infant, and wrapping it in warm flannel, place it on 
its back on a table or other article near the fire, and after re- 
moving the mucus from its mouth, she should carefully wipe 
its lips. After slight^ elevating the child's head by placing 
something under it, the nurse should then close its nos- 
trils b} 7 pressing them together with the thumb and fore- 
finger of one hand, Avhile the other is placed over the child's 
stomach, making pressure to prevent air from passing into 
that organ. The nurse should then place her lips close to 
those of the child, and blow her breath into its mouth. 
When the child's lungs have been distended in this manner 
the nurse should gently compress its chest with her hands, 
so as to force the air out. This operation of inflating the 
lungs and compressing the chest must be repeated again 
and again until natural respiration takes place, or until, 
after long-continued and unremitting efforts to restore breath- 
ing, there are no indications of success. While the nurse is 
engaged in these efforts, others can aid in the restoration of 
the child by gently rubbing its legs upwards with their 
warm hands. 

If the entrance to the windpipe be closed by the tongue 
being drawn backwards against the roof of the mouth, the 
nurse can, with a finger placed well back upon the tongue, 
draw it forwards so as to permit the air to enter the lungs. 
If this method proves unsuccessful, after a fair trial, the 
child should be placed in a warm bath for a few moments, 
the artificial respiration being kept up at the same time. 

After natural respiration has been established, it will be 
cmite feeble, and to increase the force of its breathing, the 
nurse should place the child in a warm bath up to its neck, 
and then sprinkle cold water upon its head and face. This 
usually causes it to gasp, when its lungs will become fully 
inflated with air. 



Attention to the Child soon after Birth. 63 

When the child is born apparently dead and, on examina- 
tion, the cord is found to be pulsating, or beating, it should 
not be divided ; but for the time being the child should be left 
attached to the mother. With her finger covered with a fold 
of a handkerchief, the nurse must remove any mucus that 
may be in the child's throat, so as to admit of the free 
passage of air into its lungs. Cold water should then be 
sprinkled on the child's face, and its breast slapped with the 
nurse's hand, which has previously been dipped into cold 
water. This will often cause the child to gasp, and thus fill 
its lungs with air. If these means are but partially success- 
ful, attempts should be made for a short time to establish 
respiration by the nurse applying her mouth to that of the 
child, and filling its lungs as before directed, without, how- 
ever, removing it from the mother. Assistance can be given 
by rubbing the chest, legs, and feet with warm spirits, and 
by tickling the back of the throat with a feather dipped in 
brandy or whiskey. If all these measures fail, and the beat- 
ing, or pulsation, in the cord has ceased, the nurse will re- 
move the child from the mother by tying and cutting the 
cord. She will then proceed to practice artificial respiration 
in the manner before described. 

Sometimes, in cases that seem to be hopeless, a continu- 
ance of the above methods will in the end prove successful. 
The nurse must not, therefore, be too easily discouraged, 
but should continue her efforts as long as there is the least 
hope of succeeding. 

A child may not pass water for a day or two after birth, thus 
causing great anxiety to the mother. If there is no malforma- 
tion of the parts the trouble can usually be corrected by 
placing the infant in a warm-water bath, and making gentle 
pressure with the palm of the hand over the lower pari of 
the abdomen. The nurse should carefully watch the child 
while it is in the bath, to see whether it passes water. Oc- 



64 The Mother's Hand-Book. 

easionally the kidneys are tardy in secreting urine, and 
the child does not pass any because there is none in the 
bladder. To stimulate the kidneys in these cases, four or 
five drops of sweet spirits of nitre, in a teaspoonful of melon- 
seed tea, can be given two or three times a day. 

Sometimes a young babe's boivels are obstinately constipated, 
causing pain and fretfulness. To relieve the trouble the 
nurse can use a piece of castile soap, the shape of the little 
finger and about half that size. This can be gently insinu- 
ated into the bowel and held there until it causes the 
child to strain, when the soap will be pushed out, followed 
by an evacuation of the bowels. If this method should fail, 
or if not convenient to use it, an injection of a half-cupful 
of warm water, to which a teaspoonful of melted lard has 
been added, may be used. 

A child may suffer from inflammation of the breasts soon 
after birth, they becoming swollen, hard, painful, and con- 
taining a fluid somewhat resembling milk. All that is neces- 
sary in simple cases, where the breast is merely enlarged, 
is to rub it gently with warm sweet oil. If there is much 
inflammation, with redness, pain and great swelling, a warm, 
moist poultice can be used until the inflammation and red- 
ness disappear, after which the breast can be bathed with 
sweet oil. No attempt should be made to squeeze out the 
milk or otherwise handle the breast roughly, as by so doing 
a high grade of inflammation, ending in abscess, may be ex- 
cited. 

As a result of pressure, during difficult and painful labors, 
children are sometimes born with the shape of the head greatly 
altered, being elongated. No special attention is required in 
such cases, as the head soon returns to its natural shape 
without any treatment whatever. 

Swellings upon the head of a new-born child are common, 
due also to pressure during birth. Occasional bathing with 



Attention to the Child soon after Birth. 65 

whiskey or alcohol and water will assist in promoting absorp- 
tion, and it is rare that any other treatment is needed. 

A child may be bom tongue-tied, and if it seriously inter- 
feres with nursing, it may be necessary to remedy the de- 
fect by an operation. In most cases the deformity causes 
but little inconvenience and requires no special treatment. 
If, however, the tongue is bound down by the bridle so near 
its end that the child cannot nurse without great trouble, 
causing a clucking sound when it attempts to draw milk 
from the breast, an operation is necessary. The opera- 
tion consists in dividing the bridle with a pair of sharp scis- 
sors, and should be attempted only by a physician, for, if 
unskillfully performed, troublesome hemorrhage might re- 
sult. 

Inflammation of the eyes may attack an infant soon after 
birth, and if not properly treated, the disease is liable to 
produce permanent impairment of sight. In another part 
of this book a separate article is devoted to this disease, to 
which the reader is referred. 

Ulceration of the Cord. — The cord usually separates from 
the navel in from five to ten days after birth. In most cases 
the navel is left in a healthy condition, and soon heals with- 
out trouble. This, however, is not always the case, for in- 
stead of presenting a healthy surface it may be the seat of 
what is called " proud flesh," and be slow in healing. 

An astringent powder, such as alum or tannin, can be 
sprinkled on the diseased surface two or three times a day, 
and the parts afterwards dressed with calomel ointment. 

In neglected cases, during warm weather, maggots are 
liable to get into the sore, causing a great deal of pain as 
well as trouble in getting rid of them. 

The treatment consists in keeping the parts clean by bath- 
ing with warm water, to which a few drops of alcohol have 
been added. The maggots that are within sight should be 
5 



60 The Mother's Hand-Book. 

carefully removed and the sore wet with the following mix- 
ture:. Take ten drops of carbolic acid and dissolve it in a 
teaspoonful of glycerine ; add this to two large tablespoonfuls 
of water. After wetting the sore with this mixture, it can 
be dressed with the calomel ointment. The application can 
be made two or three times a day until the parts are healed. 

Bleeding from the navel may happen when the corcl sepa- 
rates, or soon afterwards. If it be so profuse as to threaten 
life the nurse should make pressure with the point of her 
finger until a physician can be summoned. If the pressure 
does not arrest the bleeding, a small bit of sponge may be 
dipped in strong alum water, and then rolled in tannin and 
applied to the navel. Pressure should then be made upon 
the sponge with the point of the finger. Sometimes the 
bleeding consists of a mere oozing of blood from large red 
granulations that spring from the sore. The bleeding can 
usually be controlled by covering the parts with tannin or 
powdered alum or some other astringent. If these mea- 
sures fail, recourse must be had to pressure made as above 
directed. 

Children sometimes become jaundiced soon after birth, 
causing great anxiety and alarm to the mother. In most 
cases the disease disappears spontaneously, but occasionally 
it may prove somewhat serious, and require the attention of 
a physician. The reader is referred to the article on jaun- 
dice for further information. 

Infants often suffer from chafings situated about the flex- 
ures of the joints and the buttocks. The treatment consists 
in keeping the parts thoroughly cleansed with warm water, 
and using a wash composed of a tablespoonful of alcohol 
to a pint of water. When dried the parts can be dusted 
with the precipitated carbonate of zinc, or else dressed with 
the oxide of zinc ointment. 



CHAPTER IV. 



^cciitettts mti Biswases Occurring at nv 
soon after ©trtft* 



PREMATURE INFANTS. 



CHILDREN prematurely born are so weak and feeble as 
to require a great deal of care and good management 
to keep them from perishing soon after birth. They breathe 
badly, and many of them will not at first nurse their mother's 
breast; their organs are not well developed, and perform 
their functions imperfectly. They do not seem to have the 
strength to suck and swallow, the muscles of the tongue, 
cheeks and throat being too weak to perform these acts. 

That they may have a chance to live, it is necessary to 
keep them warm and give them a sufficient amount of nour- 
ishment. 

To accomplish the first object, a hatching-cradle has been 
used in France. It consists essentially of a box, properly 
ventilated, and so arranged that the air in it can be kept 
warm (about 77°) by means of jugs containing hot water. 

Any contrivance that will raise the temperature around 
the infant, while permitting it to breathe good, pure air, will 
serve the purpose. In an extreme case that once came under 
my own observation, I put the infant, thoroughly wrapped 
in flannel, into the oven of a common cooking-stove, and kept 
the heat of the stove regulated at about 77°. Of course the 

[07 J 



QS The Mother's Haxd-Book. 

doors of the oven were kept wide open, and a large sponge, 
wet with water, so as to give off a sufficient amount of mois- 
ture, was laid in the oven. If the case is so desperate as to 
require the adoption of such measures, the time and atten- 
tion of one intelligent person must be constantly given to 
the proper regulation of the heat, as otherwise the most se- 
rious consequences might result. Of course, a thermometer 
is indispensable to test the temperature around the child at 
frequent intervals. 

Children that are born prematurely are too feeble to be 
washed soon after birth. They can be placed in a warm- 
water bath, and while in the water the nurse can gently rub 
those portions of the body that are foul, after which the 
child should be quickly dried and enveloped in warm flan- 
nel. Constant attention must be given to keeping the body 
warm until the child's strength is sufficiently restored; other- 
wise the depressing effects of cold will destroy what little 
vitality its system contains. 

In most cases, frequently wrapping it in warm flannels, 
and laying it in bed beside its mother, will be sufficient. A 
thick flannel blanket should be laid on the bed, upon which 
the infant, with its flannel wraps, is placed. The tempera- 
ture of the room should be made comfortable; but on the 
mother's account it must not be too warm. About 70° is 
perhaps the proper temperature under such circumstances. 

The child must be put to the breast soon after birth, and 
every effort should be made to get it to take the mother's milk. 

If it be too weak to suck, the nipple should be squeezed 
and the milk forced into its mouth, or else some can be 
milked into a spoon and the child fed in this manner. If 
no milk can be obtained from the mother's breast, the ordi- 
nary mixture of one part of cow's milk to three parts of 
water, or the condensed milk — one part to twenty-two of 
water — can be used. If the child is very small and weak, 



Accidents and Diseases at or soon after Birth. 69 

only about a dessertspoonful of the mixture should be given 
at a time, but it should be fed this quantity every hour or 
two. Larger children will, of course, require larger quanti- 
ties. Sometimes it is impossible to get the infant to swal- 
low the milk, and it may be necessary to feed it through a 
tube introduced into the stomach. If vomiting occurs after 
feeding, no matter how the milk is introduced into the 
stomach, it will be best to decrease the quantity, as no 
more should be given at a time than can be retained. If 
diarrhoea occurs, showing that the food is not agreeing with 
the child, it will be necessary to make a change and select 
such form of nourishment as is found to be best adapted to 
the child's digestion. 

By proceeding cautiously in this manner many children 
will continue to thrive, and in a short time become as strong 
as if born at full term. Others, however, will remain small 
and delicate, requiring some years to outgrow the feebleness 
that characterized them at birth. Yet, with good care and 
management, such children may outgrow their infirmity and 
in adult life become as large and strong as if they had been 
well-developed at birth. 

SUFFOCATION OF CHILDREN IN BED. 

Suffocation of children in bed, or overlying, usually hap- 
pens during the mother's sleep while her child is nursing. 
After sucking the breast until it is satisfied, it loses the 
nipple and buries its face close against its mother's body or 
a pillow, or the bed-clothes, thus cutting off all chance of 
getting air into the lungs. It has neither the sense nor 
strength to move its face around on the bed until it can get 
sufficient air to fill its lungs, and therefore smothers io death 
beside its mother. 

To prevent this accident some have advised that the child 
should not be permitted to sleep with its mother, but should 



70 The Mother's Hand-Book. 

be placed in a crib by the side of her bed. But in early life 
an infant has but little vitality and requires to be kept very 
warm. It is best, therefore, that it should rest beside its 
mother for the first two months. If the mother exercises 
due care, there is but little danger that her child will be 
smothered in bed. She should never go to sleep while her 
child is nursing, but should wait until it has finished its 
meal, and then carefully place it in a position where it will 
have juenty of room to breathe. No pillow l or fold of bed- 
clothes, should be permitted to be near its face, and if the 
mother turns over during the night, she must have her child's 
welfare so impressed upon her mind that she will not get too 
near it. The bed should be roomy enough to permit the 
child's face to be placed at some distance from the mother's 
body. 

DEFORMITIES. 

Various kinds of deformities are met with in new-born 
children, which should not be neglected, as many of them 
are more easily removed in early life than after the child 
has attained to the age of puberty. Such cases should, 
therefore, at an early day be placed in charge of a physician 
for treatment. 

Mother's marks are sometimes seen on the bodies of young 
infants. They may be of a bright red color or of a dark, 
livid hue, the color depending upon the character of the 
blood contained in them. The name is sometimes applied 
to moles and other small tumors. The scarlet form of 
mother's marks may be quite extensive, spreading over 
a large portion of skin. When this is the case, great care 
should be "taken to prevent the child from injuring the 
part, as a wound inflicted by a knife or other sharp instru- 
ment would cause troublesome bleeding. These marks, 
usually do not increase in size after birth; indeed, many of 
them, when limited in extent and not deep-seated, disappear 









Accidents and Diseases at or soon after Birth. 71 

as the child grows older. But if they are deep-seated, or arc 
of large size, and especially if they are situated on the face 
or other exposed parts of the body, the advice of a surgeon 
should be obtained, as it may be necessary to resort to opera- 
tive measures to relieve the child of the disfigurement. 

It is a popular belief that these marks are produced by 
strong mental impressions made on the mother's mind while 
she is pregnant. In rare cases this may be true, but in- 
stances of the kind do not often occur, and most cases of 
mother's mark are due to other causes. What those causes 
are we do not at present understand. 

Hare-lip consists of fissures of the upper lip, causing an 
unsightly deformity. Usually there is but one fissure, which 
in most cases is situated on the left side. Sometimes there 
are two, one on the right and the other on the left side, 
leaving a portion of lip between them. The deformity may 
consist of fissures involving the lower portion of the lip 
only, or they may extend up into the nose. In addition to 
the fissures of the soft parts, the bones beneath may also be 
cleft, and this cleft may be limited to that portion of the 
jaw where the teeth arc inserted, or it may extend through- 
out the whole of the roof of the mouth, reaching back to 
the throat. Occasionally, though seldom, the bone may be 
divided by a fissure without there being any cleft in the lip. 

Not only does hare-lip produce an unsightly deformity, 
but it also seriously interferes with nursing, swallowing, and 
later on with articulation. It is therefore desirable that the 
deformity be remedied by an operation as early as it can be 
done with safety. Surgeons differ as to the proper time for 
performing the operation. Some contend that it should be 
done very soon after birth — from the third to the sixth 
week — while others would wait till the child has finished 
cutting its teeth. The operation cannot be performed, with 
any show of success, while the infant is at the breast ; hence, 



72 The Mother's Hand-Book. 

if an early attempt be made to close the fissure, the child 
must be weaned. No operation should be attempted while 
the child is cutting its teeth; and therefore, all things con- 
sidered, it is probably best that operative measures should 
be deferred until the child is two or three years old. 

The operation is a delicate one, and requires great skill 
and judgment on the part of the surgeon. If the case be a 
simple one and not attended with much deformity, and the 
surgeon is careful to trim the fissures in a proper manner, 
the scar or deformity left after the operation will be slight, 
and the child will escape much disfigurement. In bad cases, 
however, the results will not be so satisfactory. 

Children are occasionally born with club feet. Usually 
but one foot is affected, but sometimes both are deformed. 
There are several varieties of club foot, some being much 
harder to cure than others* The deformity caused by club 
feet is very great; besides, locomotion is sadly interfered with. 
It is, therefore, doubly important that the child should be 
cured of its defect; and it should be done at as early a pe- 
riod as possible, as it is much more easily remedied in a 
child than in a grown person. 

It being easier to restore bones to their natural position in 
children than in adults, it follows that in early childhood 
cases may be cured by mechanical appliances alone that, in 
adult life, would require the employment of the knife to 
divide tendons and other structures. 

If the infant be healthy, the surgeon can commence the 
treatment by suitable mechanical appliances at the end of the 
second month. In bad cases, it may be necessary to begin 
the treatment by dividing one or more tendons with the 
knife, even in very young infants. 

Closure of the Bowel. — Occasionally a child is born with- 
out any opening from the lower j^art of the boAvel. Of course, 
unless relief is obtained soon, the child cannot live long; and 



Accidents and Diseases at or soon after Birth. 



l 6 



hence the physician's attention should be directed to the de- 
fect without delay. Sometimes the trouble is caused merely 
by a thin skin growing over the parts. When this is the 
case, relief is easily afforded by dividing the skin at the point 
where a bulging occurs when the child strains in an effort to 
evacuate the bowels. In other cases the bowel terminates 
higher up, and it is necessary to cut through from a half 
inch to an inch of tissue before reaching the bowel. One 
case of this kind came under my own observation. Some- 
times the bowel terminates by an opening into the bladder, 
and the matter from the bowels flows through the urethra 
mixed with urine. Such cases are hopeless, the child dying 
in a few days after birth. 

The urethra may he closed in a new-born infant, and as a 
consequence the urine cannot flow out of the bladder. The 
urethra (the canal leading from the bladder outwardly, 
through which the urine passes) is closed at some point of 
its course, and in some cases no external opening can be 
seen. Sometimes the urethra is perfectly formed for two 
inches or more from the bladder, and a minute opening can 
be discovered by a careful inspection of the skin on the 4 
lower surface of the penis, which, on being enlarged, per- 
mits the urine to flow without much difficulty. 

. Film. Growing Over the Eyes. — In very rare instances chil- 
dren are born with a thin film of skin growing over the 
orbits, entirely concealing both eyes. Such children are 
spoken of by non-professional persons as having been born 
without eyes, yet this is a mistake. The eyes occupy their 
usual position, but a layer of skin has grown over them, 
hiding them from view. In such cases a physician can 
sometimes remedy the defect by carefully removing the 
superabundant skin by operative procedure. 

Bowed leys may exist in various degrees, some cases pre- 
senting very slight curvature, while in others the deformity 






74 The Mother's Hand-Book . 

is so great as to require long and continuous treatment for 
its correction. If the bend in the legs of a young child be 
slight, no special treatment need be adopted, as it will out- 
grow the deformity before adult age. But if the deformity 
is great the patient must be placed in charge of a surgeon 
for proper treatment. 

Spina bifida is caused by a malformation cf the spinal 
column in some part of its course. A fissure or cleft in the 
bone permits of the protrusion of the membranes covering 
the spinal cord, which, as they bulge outwards, form a sack 
at some part of the spine. The sack, being filled with water, 
gives a feeling of fluctuation, and by firm pressure it can be 
diminished in size, and in some cases emptied. As soon, 
however, as the pressure is withdrawn the sack begins to re- 
fill. Ordinarily the membranes of the cord, which consti- 
tute the walls of the sack, are covered with a thin skin; but 
sometimes the skin is wanting, when the sack is plainly seen 
as it passes through the opening formed by the absence of 
skin and other tissues. 

The tumor may be quite small at first, but soon increases 
in size, becoming as large, in some cases, as the child's head. 
The size and shape of the tumor will depend to a great ex- 
tent upon the amount of deficiency that exists in the bones 
of the spinal column. 

Death nearly always takes place in a short time after the 
birth of children affected with spina bifida, being usually 
preceded by convulsions. Rupture of the sack from ulcera- 
tion, and escape of its contents, is quickly followed by 
death. 

The treatment of this deformity is very unsatisfactory. 
When the tumor is small, gentle and continuous pressure 
has been tried, but without much success. Small subcuta- 
neous punctures, to drain the sack of its contents, have been 
made, with results not encouraging. 



HERNIA, OH RUPTURE, AT BIRTH. 

If the inguinal canal is not closed before birth, the child 
is liable to suffer from a descent of a portion of the bowel 
through it, constituting hernia, or rupture. 

The swelling, or tumor, is usually small and easily reduced, 
but occasionally it is of large dimensions. 

The treatment consists of reducing the rupture by pres- 
sure upon the tumor, and applying a properly constructed 
pad to keep the bowel from again descending. After the 
child is a year old it can wear an infant's truss, which, if 
properly applied and worn, will usually effect a radical cure. 
While wearing a truss, the tender skin of the infant is liable 
to become irritated or inflamed. The parts should be fre- 
quently bathed in warm water, and a mild ointment after- 
wards applied. 

These cases should be treated only by a competent physi- 
cian. 

JAUNDICE. 

The skin of a new-born child is of a vivid red color, which 
gradually fades, until, in the healthy babe, it becomes of a 
rose tint. In some cases, within three or four days after birth, 
the skin loses its red color and assumes a yellowish tinge. 
The child is really not sick, and but for the peculiar color of 
the skin it would not cause its mother any uneasiness. Its 
bowels act naturally, and the urine may or may not be high- 
colored. The eyes do not become yellow as in true jaun- 
dice, and the discharges from the bowels show no absence 
of bile. 

The cause of the trouble is a matter of doubt, though in 
some cases the exposure of the child to the influence of cold 
in washing and dressing is sufficient to account lor it. 

This disease is not of a serious character, and if left to 
itself will end in recovery in a short time. If, however, the 



76 The Mother's Hand-Book. 

bowels are costive a small dose of syrup of rhubarb, or cas- 
tor oil, may be given. 

In rare cases, the child may be the subject of true jaun- 
dice. If so, the skin assumes a deeper yellowish tinge; the 
eyes become yellow; the discharges from the bowels are un- 
usually whitish in appearance, showing an absence of bile; 
the urine is high-colored, giving a yellow or saffron-colored 
stain to the diaper. The child loses weight, and there are 
disturbances in the digestive organs. 

Careful examination may disclose an enlargement of the 
liver, the lower border of which can be felt in the abdo- 
men below the ribs, constituting what nurses call " liver- 
grown." 

In the treatment of this form of the disease the child's diet 
must be carefulty attended to. If its milk or food is not 
agreeing with it a change must be made; the quantity, in 
most cases being too great, should be reduced to correspond 
with the inability of the stomach to digest its usual amount 
of nourishment. Sometimes it is necessary to change the 
kind of food, selecting an article that is easier of digestion 
and gives less trouble to the weakened stomach. Warm 
baths, followed by gentle friction, will be useful. If there 
be no diarrhoea the syrup of rhubarb, to occasionally move 
the bowels, will be proper. Four or five drops of the sweet 
spirits of nitre in a teaspoonful of water or melon-seed tea 
will have a good effect on the kidneys, stimulating them to 
action, and thus aiding in the elimination of the coloring 
matter of the bile from the blood. 

INFANTILE LOCK-JAW. 

This affection may show itself in a few hours after birth, 
but often a week elapses before it makes its appearance. It 
comes on gradually; the first thing usually noticed is that 
the infant, when placed at the breast, does not take the nipple. 



Accidents and Diseases at or soon after Birth. 77 

On examination the mouth is found to be closed ; the jaws 
almost so, and firmly locked. Soon after convulsions oc- 
cur in paroxysms, being ushered in by a shriek. During 
their continuance the body is livid, the hands are strongly 
clenched, the feet flexed on the ankles, and the toes drawn 
inwards, remaining so during the fit; the body is bent back- 
wards, the mouth is slightly open, and the lower jaw is firmly 
fixed. Even after the fit is over the hands remain clenched, 
the thumbs drawn into the palm, and the head is drawn 
backwards. As the disease advances the jaws become quite 
closed, the lips being firmly compressed against the gums. 
The child is unable to suck almost from the beginning of 
the attack. 

Death may occur during a fit, or the child may sink into 
a condition of insensibility or profound sleep, and so expire 
within twenty-four or thirty-six hours from the commence- 
ment of the disease. 

The cause of the disease is not well understood; but most 
likely pressure upon the brain during birth is the most com- 
mon. In some cases of difficult labor the bones of the child's 
head are found overlapping each other, the bone at the back 
of the head being depressed, and those at the sides riding 
over it at the edges. When this is the case the child should 
never be laid on the back, but on the side, so as to give the 
bone a chance to assume its proper position. This, and giv- 
ing the child an occasional warm-water bath, is about all that 
flie nurse can do in this disease, which is nearly always a 
fatal one. 

INFLAMMATION OF THE EYES. 

On the third day after birth, sometimes later, a child may 
be attacked with a severe form of inflammation of theeyes, 
which, if not properly treated, is liable to cause impairment 
of sight. 



78 The Mother's Haxd-Book. 

This disease is produced by inoculation in the mother's 
passages during the birth of the child. Women suffering 
from severe leucorrhcea, or "whites," at the time of confine- 
ment, are liable to inoculate the infant's eyes. When this 
is the cause, the disease will nearly always be noticed on 
the third day after birth. In other cases the trouble arises 
from carelessness and neglect in washing the child. Cloths 
impregnated with diseased germs from sores or foul dis- 
charges are used about the eyes, and the infant in this man- 
ner becomes infected. 

Nurses often express the opinion that the disease is pro- 
duced by exposing the child's eyes to a strong light, and 
are apt to censure the attending jdiysician for permitting too 
much light in the room after the child is born. There is 
most likely no foundation for such an opinion; but, of course, 
the bright light from a lamp or a gas-jet should not be per- 
mitted to fall upon the child's eyes. 

The symptoms of the disease are swelling of the eyelids, 
with redness or a livid hue of the skin about the lids, the 
margins of which stick together closely. When the lids are 
separated a purulent discharge escapes in great quantities. 
These acute symptoms may continue for a week or so, when 
they begin to subside, assuming a milder form, although the 
discharge from the eyes may last for a much longer period. 
Both eyes may become diseased at the same time; but usually 
one is affected two or three days before the other is involved. 

When a woman who suffers from leucorrhcea, or whites, 
is near her confinement, she should use warm water injec- 
tions morning and night to wash away the acrid discharge; 
and after each one, while lying on her back, she should in- 
ject a mixture of alcohol, one part to eight parts of water. 
In using these injections the syringe should be fitted with a 
tube, the perforation in the end of which ought to be closed, 
so that the fluid will pass out at the side openings only. 



Accidents and Diseases at or soon after Birth. 70 

Treatment. — After the child's eyes have become inflamed, 
the most persevering care and attention must be given to 
the case by the nurse; otherwise total blindness may follow. 
During the whole progress of the disease pains must be 
taken to prevent the matter from the diseased eye getting 
into the sound one; and to do this the child should be laid 
on the affected side, so that the discharge may escape with- 
out running into the healthy eye. The infant's hands should 
be so confined as to prevent it from inoculating the sound 
eye with matter carried from the diseased one. All cloths 
and sponges used about the patient must be carefully taken 
out of the room and destroyed. The eyes should be kept as 
free as possible from the discharge, and for this purpose the 
lids must be carefully separated every hour or two to enable 
the matter to escape, after which the eye should be bathed 
with warm water by letting it fall in a small stream from a 
bit of sponge held just above the head. Sometimes a very 
small syringe is used to wash the matter from beneath the 
eyelids. The application of washes and ointments to the 
eye should be made only by a physician having a knowledge 
of eye-diseases. 

The cornea, or front part of the eye-ball, is liable to be- 
come seriously affected in this form of inflammation of the 
eyes, constituting the principal danger in this disease. Ul- 
cers of the cornea may occur, which in healing leave a scar, 
or opacity, that interferes with the transmission of light to 
the retina. Cleanliness, and prompt removal of the dis- 
charge from the eye (not permitting it to remain long in 
contact with the eye-ball), are the best means of avoiding 
corneal troubles. 

COLIC. 

As a result of taking too much food at a time, or food oi' 
an improper quality, children are subject to indigestion thai 



SO The Mother's Hand-Book. 

often leads to attacks of colic. In very young infants, colic 
is usually caused by over-nursing; the stomach becoming so 
much distended as to cause pain. In other cases the 
mother's milk is not healthy, and the child suffers as much 
from the quality as from the quantity. 

When the child grows older, and is being fed from the 
table, it is not unusual for it to suffer from acute colic caused 
by eating some improper article of diet. Food that under- 
goes fermentation, or decomposition in the stomach and 
bowels, gives rise to distention of the abdomen with wind, 
thus producing the severe pain with which the child suffers 
during an attack of the disease. 

Infants that have an occasional attack of colic, caused by 
over-distention of the stomach with milk, or other diet, may 
be fat and otherwise healthy; but where the indigestion be- 
comes chronic from persistent over-feeding, or giving im- 
proper food, the child's digestive organs are weakened, and 
it is not able to digest and assimilate enough food to properly 
nourish the body. In such cases it becomes weak, pale, dull 
and fretful. Very often the disease is made worse and more 
protracted by the repeated administration of soothing syrup, 
paregoric and similar medicines, given to control the pain 
from which the child suffers. 

Improper treatment during the first few days of infantile 
life may be the foundation for future attacks of colic. The 
administration of toddy, catnip and other teas, soon after 
birth, is usually followed by disturbance of the stomach that 
leads to indigestion. 

Treatment. — The first thing necessary to do in the treat- 
ment of colic is to see that the child's food is of suitable 
quality and that it is given in proper quantities. If the 
child be nursing its mother, the probabilities are that it takes 
more milk into its stomach than can be properly digested, 
and measures must be adopted to restrict the amount taken 



Accidents and Diseases at or soon after Birth. 81 

at each meal. It is a good plan to give the babe a little cold 
water before it takes the breast, to cool its mouth and allay 
its thirst, so that it will not be so apt to crowd its stomach 
with milk. At any rate it must not be permitted to nurse 
too long at a time, and when- the mother thinks it has taken 
a sufficient quantity of her milk it must be taken from the 
breast. If it becomes necessary to greatly decrease the 
amount of milk taken at a time, it may be best to let the 
child take the breast a little oftener than usual. 

In some cases the trouble may be caused by the mother's 
milk disagreeing with the child, and if so, it should be taken 
from the breast and fed with such artificial food as may be 
found to best agree with it. 

Children that are being artificially fed may suffer from colic. 
In such cases the food has been given too often, or too much 
at a time, or else it is not adapted to the child's system. 

The management of such cases consists in giving less food 
at a time and at proper intervals. If this does not remove 
the trouble, it will be necessary to change the food and select 
some article more suitable to the child's wants. 

To relieve the pain that attends colic, it will usually be 
best to give a dose of castor oil with a few drops of pare- 
goric added to it. A teaspoonful of castor oil and five or six 
drops of paregoric will be sufficient for a very young child. 
The action of the oil can be hastened by using an injection 
of a half teacupful of warm water. When the bowels move, 
a quantity of wind will escape with the discharges, giving 
relief to the sufferer. 

Cloths wrung out of hot water should be placed over the 
whole of the child's abdomen. These should be frequently 
changed in order to keep up the effects of the moist heat. 
If this docs not give relief to the pain, the child may be put 
into a hot bath for a few minutes, after which the hot clot lis 
can be re-applied. 



82 The Mother's Haxd-Book. 

When the pain is excessive, and the above treatment does 
not give relief, it may be necessary to give the child some 
preparation containing opium. For this purpose small doses 
of paregoric, say five to ten drops, in a teaspoonful of water, 
will be proper. Three or four drops of the essence of pep- 
permint added to the paregoric Avill increase its efficiency. 
Usually after taking this medicine the child will belch up 
considerable wind from the stomach. 

When an attack of colic is caused by eating indigestible 
articles, the first thing to do is to get rid of the offending 
substances by an emetic, such as ipecac or mustard and wa- 
ter. As soon as this has been accomplished a dose of castor 
oil, with a few drops of paregoric, should be given to move 
the bowels. An injection of warm water, shortly after giv- 
ing the oil, will hasten the action of the purgative. 

In rare cases the pain that accompanies inflammation of 
the bowels may be mistaken for colic, and it is important 
that the mother should be able to distinguish the symptoms 
of the two diseases, for the reason that inflammation of the 
bowels is attended with great danger to life, and calls for 
prompt medical assistance. 

In colic from indigestion, firm pressure on the abdomen 
does not increase the pain, but rather mitigates it; while in 
inflammation of the bowels, pressure produces excessive 
pain, causing the child to scream with agony when the hand 
is firmly pressed on the belly. In addition to this the pain 
in inflammation of the bowels is constant, never entirely 
subsiding, while in colic it is paroxysmal, the child at times 
being entirely free from it. 

If the mother has reason to believe that her child's symp- 
toms j)roceed from inflammation of the bowels, she should 
at once send for a physician, as, with the exception of the 
hot-water bath and hot cloths to the abdomen, the remedies 
above mentioned are not adapted to the treatment of the 
latter disease. 



INFANTILE ERYSIPELAS. 

This disease, although quite rare, is occasionally met with, 
and is due to a variety of causes. Thus, if a mother has a 
severe attack of erysipelas at the time of her confinement, 
she will most likely give birth to a child covered with the 
erysipelatous rash. Also, when the mother is suffering from 
child-bed fever there is danger that the child will have ery- 
sipelas. Sometimes the disease starts from a sore, such as an 
unhealed navel, and rapidly spreads over the whole body. 
In other cases erysipelas may arise from a wound, such as is 
made by vaccination, or by a burn, or by the application of 
a blister. Occasionally the disease cannot be traced to in- 
fection, or to an injury of any kind, it being a constitutional 
form of erysipelas. 

If the disease be caused by infection from the mother, or 
from a navel sore, it will appear within a very few days after 
birth. Cases arising from wounds and other causes may be 
met with at a much later period. 

Infantile erysipelas is always dangerous, and when it is 
the result of infection from the mother it will usually result 
fatally. When arising from sores, recovery may take place, 
though this is perhaps the exception, and not the rule gov- 
erning such cases. 

When erysipelas is the result of infection, the symptoms 
are usually violent from the start. A patch of bright red- 
ness, attended with swelling, and having distinct and well- 
defined margins, appears upon some part of the body. Even 
if the inflamed spot is small, the child will have high fever 
and will suffer from pain, manifested by crying, and present 
all the appearances of being very sick. The inflammation 
will spread rapidly, still showing the well-defined borders 
that accompany an erysipelatous rash, while the fever still 
continues unabatejl, and the child grows rapidly weaker and 



84 The Mother's Hand-Book. 

more debilitated. In a little while the eruption spreads 
from the body to the limbs, covering the whole surface of 
the child in many cases. The abdomen is swollen, caused 
by the bowels being distended with gas. Vomiting and 
diarrhoea set in, and death may be preceded by convulsions. 

When erysrpelas arises from a sore, or injury, the symp- 
toms may not be so violent. The rash may start at the 
navel when sore, or. at some other unhealthy part of the 
body, and spread with considerable rapidity. As the erup- 
tion extends to other parts it loses some of its redness at 
the original site, although the skin does not usually return 
to its healthy color at any affected place while the disease 
continues to spread. The child may continue to take its 
food and have a fair digestion, even though the eruption is 
extensive; and in a week or two convalescence may be es- 
tablished. 

In severe cases the child refuses the breast, and will take 
no nourishment. The fever remains high; vomiting and 
diarrhoea supervene, and death soon takes place. 

Many complications may arise during the progress of a 
case of erysipelas. Inflammation of the bowels and pneu- 
monia sometimes occur. Abscesses in different parts of the 
body and sloughing of the skin may happen. 

Erysipelas might be confounded with scarlet rash, but 
being a much severer disease than the latter, its symptoms 
are altogether more aggravated. The fever of scarlet rash 
is slight, and subsides in a day or two, while in erysipelas it 
lasts during the continuance of the eruption. In scarlet 
rash the redness is diffused, having no defined margin, but 
shades off so gradually that it is difficult to tell exactly where 
the rash ends and the healthy skin begins. In erysipelas 
the margin of redness is well defined and the line between 
the rash and the unaffected skin is well marked and can 
easily be seen. 



Accidents and Diseases at ok soon aftek Bikth. 85 

I have seen cases of erysipelas, where the disease com- 
menced at the navel and extended over the whole body, re- 
cover in two or three weeks, the skin peeling off, to some ex- 
tent, as in scarlet fever. 

The medical treatment of infantile erysipelas should be con- 
ducted by a physician; but an intelligent nurse can do a 
great deal of good by aiding the medical attendant 'in his 
efforts to restore the patient. 

If the mother is suffering from "lying-in fever," the child 
must not on any account be permitted to take her milk. It 
must be fed with diluted cow's milk, or, if that disagrees 
with it, with condensed milk prepared as heretofore directed, 
or with some other form of infant food suitable to one of its 
age. Only such nourishment as is found to agree with its 
stomach and bowels should be given. 

Various kinds of local treatment have been advised in this 
disease. Even the plan of drawing a line around the rash 
with a stick of caustic has been tried on the tender skin of 
a young infant. Such an application is both barbarous and 
dangerous. It is not the eruption on the outer surface of 
the skin that destroys life, but the complications that occur 
during the course of the disease, or the wearing out of the 
vital powers from the fever, or the action of the poisonous 
material upon the blood. 

Whatever application is used upon the inflamed skin, it 
should be of a mild and bland character, the object being 
mainly to exclude the air from the diseased surface, thereby 
relieving the burning and pain that attends the eruption. 

The oxide of zinc, finely powdered, and mixed witli enough 
gtycerinc to form a thick paint, will be found useful. 

The white lead paint may be used with benefit in cases 
where the eruption is not extensive. It relieves the pain 
and burning sensation quickly, and under its influence the 
child becomes quiet, while the general symptoms assume a 
more favorable character. 



CHAPTER V. 



®eg1ltint$, or ©entlilotu 



THE process of dentition is attended with danger to the 
child, and hence it is a period of great anxiety to the 
mother. Many infants that have before been healthy and 
robust become feeble and lose their flesh when they begin 
cutting their teeth. While dentition cannot be considered 
a disease of itself, yet, at this period of life, children are 
peculiarly liable to become sick from causes that at other 
times would not greatly affect their general health. This is 
due to the active changes that are taking place in the differ- 
ent organs of the body. 

At this stage of infantile life there is considerable de- 
velopment of the glands of the stomach and intestines that 
are concerned in the process of digestion and absorption. 
The nervous system is in a condition of rapid growth and 
high functional activity. The irritation produced by a tooth 
that is about to appear through a gum is often sufficient to 
induce, not only an inflamed condition of the mucous mem- 
brane of the mouth, but also a fever that affects the whole 
system. This reacts upon the nervous system, through the 
influence of which great disturbances are witnessed in the 
various muscles of the body, such as twitching of the mouth, 
the hands, the feet, and, in some cases, general convulsions. 

When suffering from fever, a child's digestion is weak- 
ened, and food that had before agreed perfectly well with it 

[86] "" 



Teething, or Dentition. 87 

cannot bo borne — at least not in the usual quantity. Hence 
arise derangements of the digestive organs, as manifested 
by frequent vomiting and purging. In such cases the diar- 
rhoea and vomiting arc the result of the fever from which 
the child suffers, while the fever itself may be caused by 
the teething. It will thus be seen that diarrhoea during 
dentition is not directly, but indirectly, caused by teething. 
Owing to the heat of the body, the diet, instead of supply- 
ing the child with the required nourishment, ferments, 
turns acid, and produces diarrhoea, which, unless properly 
treated, may end fatally — the child dying from lack of nu- 
trition, due to forcing upon its stomach food that it cannot 
digest and assimilate. 

Because of the early age of the child and the conditions 
above mentioned, the first dentition is more liable than the 
second to be accompanied by serious disturbance of the 
general health; but even when cutting the second crop of 
teeth, digestive troubles may occur. Some children suffer 
much more than others during the period of dentition — 
many being quite sick each time that a tooth is about to 
make its appearance, while a few cut their teeth without 
being in the least affected by the process. It is difficult to 
assign a reason for this difference; but it would seem to de- 
pend more upon individual peculiarities than upon actual 
bodily health. Teeth may be cut early, and yet the process 
may be attended with considerable suffering, while delayed 
dentition may be unaccompanied by much trouble A child 
that is usually healthy may become very sick during the 
time it is cutting its teeth, while another with inherited dis- 
ease may suffer but little, if any, inconvenience. 

Ordinarily children begin to " cut their teeth " at or about 
the seventh month; but this rule is subject to many ex- 
ceptions. Thus, while in very rare eases a child may be 
born witli one or two visible teeth, in others (be process oi' 



88 The Mother's Hand-Book. 

dentition may be delayed considerably beyond the seventh 
month. 

The four front teeth — two in the middle of each jaw — usu- 
ally appear about the seventh month. Ordinarily the two 
lower- teeth are cut first. Between the seventh and tenth 
months the teeth on each side of the above appear — the two 
in the lower jaw usually first. 

Soon after the twelfth month the first grinding teeth 
come through — two in each jaw — a space being left between 
them and the teeth that have already come through. 

Between the fourteenth and twentieth months the spaces 
above mentioned are filled by the canine teeth — two in each 
jaw. The lower of these are called "stomach" teeth and 
the upper are called "eye" teeth. 

Between the eighteenth and thirtieth months four more 
grinding teeth — two in each jaw — appear. These complete 
the first set, or " milk" teeth, as they are called. 

Symptoms. — In favorable cases the general health is but 
little disturbed. There is an excessive secretion of saliva, 
and the child may have two or three operations of the bow- 
els in the twenty-four hours. Possibty it may be a little 
restless and feverish, and inclined to bite the nurse's finger, 
or other substance, that is placed in its mouth. After a few 
days the point of a tooth makes its appearance through the 
gum, to be followed in a short time by the remainder of the 
crown. The slight derangement of health that may have 
occurred soon disappears, to return only when another tooth 
begins to come through the gum. 

There is often, however, a great departure from the above 
conditions. Instead of two or three operations a day there 
may be a profuse diarrhoea, often accompanied with obsti- 
nate vomiting. The fever, instead of being slight, may be 
of a very grave character, and is usually higher in the morn- 
ing than at night; in this respect differing from fever due to 



Teething, or Dentition. 89 

other causes. The skin is hot and dry, and the sloop, in- 
stead of being quiet and restful, is greatly disturbed, the 
child twitching and starting and sometimes awaking in great 
terror. Convulsions may occur, so great is the disturbance 
of the nervous system. 

During the day the child is restless and irritable. A copious 
secretion of saliva takes place, which flows from its lips over 
its chin. It occasionally gives a quick cry and contracts 
its features as if in pain. It makes " munching " move- 
ments with its jaws, sucks its lips, and gives every indication 
of uneasiness in its gums. 

These symptoms do not, in all cases, indicate that a tooth 
is ready to come through the gum. Indeed, such attacks 
often occur days, or even weeks, before the tooth becomes 
visible, unless measures are taken to hasten its appearance. 

It is a popular belief, confirmed by experience, that the 
cutting of the " eye " and " stomach " teeth is especially apt 
to be attended with vomiting, diarrhoea, and fever. 

Complications, consisting of disorders of the mouth, stom- 
ach, respiratory organs, and the nervous system, may im- 
peril the life of a child that is teething. Of these, vomiting 
and diarrhoea are the most common. As before stated, the 
increased heat of the body j)roduced by the fever that is 
usually present during dentition, is often sufficient to cause 
fermentation of the food in the stomach and bowels. This 
gives rise to vomiting and to purging, the discharges from 
the bowels being of a yellow or green color and mixed with 
lumps of curd or undigested milk. 

Redness and inflammation of the gums and cheeks are 
often present when the tooth are about to make their ap- 
pearance. Sometimes an eruption, consist ing of vesicles 
the size of a pin's head, and of a gray or yellowish color, 
are discovered on the insido of the lower lip, the gums and 
the cheeks. This eruption is known as apthse, and usually 



90 The Mother's Hand-Book. 

disappears in a few days under judicious treatment. Some- 
times, however, the eruption is extensive, and is spread over 
a portion of the tongue, which, becoming sore, causes the 
child to suck with great difficulty, and sometimes to refuse 
the breast altogether. In extreme cases the child's condition 
may become serious. The saliva runs from its mouth, the 
breath is offensive, and, being able to take but little nourish- 
ment, it rapidly loses flesh and becomes greatly emaciated. 

Ear-ache is a most painful affection to which children are 
subject during teething. It is most likely caused in many 
cases by the inflammation extending from the mouth to the 
middle ear along the eustachian tube. Some authors, how- 
ever, believe that the irritation from an inflamed gum, being 
conveyed to the nervous centres and thence deflected to the 
blood vessels supplying the ear-drum, causes inflammation 
of that structure, thus producing ear-ache. 

Catarrh of the air passages may occur during the cold, damp 
weather of winter or early spring. This is owing to the fact 
that the fever and the irritable condition of the nervous sys- 
tem, so often attending dentition, by their debilitating effects 
upon the child, render it peculiarly susceptible to the inju- 
rious effects of cold and disagreeable weather. The disease 
is always attended with considerable fever, hurried breath- 
ing, and more or less cough, which may have a croupy sound. 
By proper treatment the disease can usually be controlled in 
a short time; but if neglected, and if the child is further ex- 
posed to the influence of cold, or to draughts of air, bron- 
chitis or broncho-pneumonia may result. 

Eruptions of various kinds are prone to occur upon the 
skin of a child when it is cutting its teeth. Many of these 
eruptions are of a simple character and soon disappear; 
while others, such as eczema, may prove exceedingly trouble- 
some and difficult to cure. Indeed, the latter disease, when 
it appears upon a child's skin while it is teething, often 



Teething, or Dentition. 91 

spreads with great rapidity, and may in a short time cover 
a great part of the body. 

Owing to the rapid development of the nervous system in 
children at the time of dentition, nervous disorders are both 
frequent and dangerous. The morbid and excitable condi- 
tion of the nervous centres at this time is such that an irri- 
tation which at a later period of life would not be serious is 
often sufficient to produce great disturbance' of the sleep, 
with startings and twitching of the muscles, and in some 
cases even convulsive attacks. That the irritation caused 
by a tooth pressing upon a tender, swollen and inflamed 
gum may be sufficient to cause convulsions cannot, I think, 
bo doubted. 

Treatment. — Children that arc teething should be comfort- 
ably dressed, and wear flannel next to the body. In cold 
weather the abdomen must be kept well protected, and the 
child should not be exposed to the cold out-door air. 

The diet must be carefully guarded, and all articles that 
arc likely to undergo fermentation in the stomach and bow- 
els must be withheld. Food that is irritating or indigesti- 
ble must not be allowed, and the greatest judgment should 
be exercised in selecting such nourishment as will agree with 
the child and be easy of digestion. 

The skins and seeds of fruits arc wholly indigestible, and 
rarely fail to produce serious irritation of the bowels. Sour 
and unripe fruits of all kinds must be rigidly excluded from 
the child's diet, and to this end parents cannot be too watchful. 

Vomiting can usually be controlled by the application of 
a weak mustard plaster over the stomach, and the withhold- 
ing for several hours of all food and drink from the child, 
except an occasional spoonful of cold water to allay its thirst. 

During the time when a child is teething, its bowels should 
be kept open so as to have one or two operations a day. But 
should the operations be oftener than this, and especially if 



92 The Mother's Hand-Book. 

they are watery and offensive, such measures must be taken 
as will tend to restrain them. If the looseness of the bowels 
is allowed to continue without treatment there is danger that 
the attack will in the end terminate in cholera infantum, or 
ileo-colitis. 

A child that has been suffering from diarrhoea is often 
unable to stand the extreme heat of the summer months, 
and is liable to be seized with cholera infantum, a disease 
that under these circumstances may cause death in a short 
time. Therefore, diarrhoea in a young child should always 
receive careful attention, and it must not be forgotten that it 
is a disease much easier arrested at the beginning than after 
it has continued a long time. 

Many mothers believe that diarrhoea is a natural attend- 
ant upon teething, and make no attempt to correct the dis- 
ease. This is a serious mistake, and while care should be 
taken that the child's bowels do not become constipated, it 
is equally necessary to overcome any tendency to continued 
diarrhoea, as it prostrates the little patient at a time when it 
should be increasing in strength. 

In the treatment of the eruptions that appear upon the 
cheeks, the tongue and the inside of the lips, absolute clean- 
liness must be observed. With a soft muslin rag that has 
been dipped into warm rain water, the parts must be gently 
but thoroughly washed several times a day. No rubbing of 
the surface should be permitted; but with a wet rag, or mop, 
any foreign matter should be removed, and afterwards the 
sores can be wet with a mixture of alcohol, tannin and water 
applied by means of a camel's-hair brush. An even tea- 
spoonful of tannin, added to a teaspoonful of alcohol, and 
two tablespoonfuls of water, will make a mixture sufficiently 
strong for this purpose. If the child be nursing its mother 
her nipples must be treated in like manner; otherwise they 
may become affected with the disease. 



Teething, or Dentition. 93 



The treatment of earache is given at some length in Chap- 
ter XXIII of this book. 

A child afflicted with catarrh of the air passages while teeth- 
ing must be carefully guarded from exposure to cold and 
from draughts of cold air. The room in which it is confined 
should be of moderate temperature and properly ventilated. 

The child's clothing should be sufficiently warm, and that 
worn next to the body should be made of flannel. If there 
is much fever, with a hot, dry skin, the mother can occa- 
sionally administer a few drops of sweet spirits of nitre in 
a little water. Stimulating liniments or a weak mustard 
plaster applied to the upper front part of the chest will be 
beneficial. 

Catarrh of the air passages occurring during dentition 
is a disease that may become dangerous unless properly 
treated, and the mother should always seek the advice of a 
medical practitioner when possible. 

Eruptions of a simple character that appear upon the skin 
of a child during the process of teething can usually be con- 
trolled _ by bathing the parts with a weak solution of sugar 
of lead, and afterwards applying the oxide of zinc ointment. 
If the eruption assumes the form of eczema, or of scald head, 
it will most likely last a long time, and be very difficult to 
cure. For information in regard to the treatment of these 
diseases, the reader is referred to the articles on eczema and 
ringworm to be found in Chapter XVIII. 

The nervous disorders of children during dentition should 
always receive careful attention. If a child that is teething 
is observed to have starts and twitches while asleep ; if its 
eyes arc only partially closed, leaving the white pari ex- 
posed; if it wakes easily, starting up in a condition of alarm 
at the slightest touch, the mother should understand thai 
her child may be in danger of having convulsions, and 
should consult a physician without delay. In the meantime 



94 The Mother's Hand-Book. 

she can place it in a warm bath — if it be not afraid of the 
water — which may, in mild cases, soothe the nervous sys- 
tem, so that its sleep will be quiet and refreshing. 

When a tooth is ready to make its appearance the gum 
over it will be found swollen and red, and the child will 
often give signs of being in pain, even when it seems to be 
otherwise in ordinary health. The pressure upon the con- 
gested gum produces pain that is not relieved until the tooth 
becomes visible. If a hard substance be given the child it 
will close its gums upon it, although the act may increase 
its pain. Under these circumstances it should be given an 
ivory ring, or, what is better, a thick piece of bread-crust 
that has been baked until it is very hard, the biting of 
which will assist the tooth in making its way through the 
gum, after which the trouble is at an end. But if these 
means do not succeed, and if the gum becomes swollen and 
of a purplish color, and especially if diarrhoea and vomiting 
supervene, it will be necessary to divide the gum with a 
knife or lancet. 

This operation, though trivial in character, requires some 
skill in its performance, and should be done only by a 
physician. If it be necessary to cut the gum over one 
of the front teeth it will be sufficient to make one incision 
in a line with the jaw. The point of the knife must be 
carried down to the tooth, and the incision made suffi- 
ciently long to enable it to project through without diffi- 
culty. When this has been done, it is best to insert the 
point of a dull knife-blade into the incision on each side, 
and press the gum from the tooth. If it becomes necessary 
to cut the gum over a grinder tooth, it must be done by mak- 
ing two incisions over the crown — one on a line with the jaw 
and the other at right angles to the first. 

The two incisions should cross each other over the centre 
of the crown. Then with the point of a dull knife-blade 



Teething, ok Dentition. 95 

press the divided gum from off the top of the tooth and 
away from its sides. 

If these instructions are carefully followed, and the gum 
is not cut at too early a stage, the tooth in each instance will 
make its appearance in two or three days after the operation. 
In performing this little operation it is best to use a knife 
that is not too sharp. A somewhat dull knife will do the 
work as well, and is not so dangerous in case it slips off of 
the tooth. 

It may be urged by the mother that a dull knife should 
not be used because it would give the child more pain than 
would a sharper instrument. The fact is, however, that the 
cutting of a swollen, discolored gum seems to give a child 
but little, if any, pain. I have often cut the gums of chil- 
dren without the little ones giving the least sign of suffering 
from the operation. 

As before stated, the gums should be cut only by a physi- 
cian, as, in rare cases, some trouble may arise from bleeding. 
This, however, will never result from a proper division of the 
gums in a healthy child; but if it be suffering from that dis- 
ease of the blood known as purpura hemorrhagica, the opera- 
tion may be a very dangerous one. Hence, if large purple 
spots be found under the skin on the body and limbs of a 
child, caused by extravasation of blood at these points, the 
physician should not on any account cut the gums, as fatal 
bleeding might follow. Indeed, the mere scratch of a pin 
might, in such a case, cause death from loss of blood. Medi- 
cal writers have reported cases where death followed scarifi- 
cation of the gums, it being impossible to arrest the How of 
blood, 



CHAPTER VI. 



llursittg mt& f^eftlng* 



THE mother must not only be careful in regard to the 
nursing and feeding of her child, and to the preparation 
and the quantity of its food, but she must also remem- 
ber that any deviation from good health on her part will 
affect her offspring through the medium of her milk. She 
should obtain a sufficient amount of sleep, and as much as 
possible avoid becoming over-heated before giving her child 
the breast. She should also cultivate an even temper, for 
if she allows herself to be overcome by fits of anger before 
nursing her child, the milk will be almost certain to dis- 
agree with it. 

If the mother's health is bad and the child shows symp- 
toms of becoming sick from nursing, no time should be lost 
in taking it from the breast and giving it to a healthy wet- 
nurse, if one can be found, or else placing it upon such arti- 
ficial food as may agree with it. If the mother's bad health 
is only temporary, the child can again be put to the breast 
when she has recovered, but if her ill health continues, the 
weaning must be permanent. 

The mother must avoid unwholesome articles of diet, such 
as salads, pickles, cucumbers, acids, etc. Spirituous and 
malt liquors should not be taken unless they are prescribed 
by a physician. 

When a nursing child has diarrhoea, the mother should 
avoid all purgative medicines, for, through the medium of 

[96J 



Nursing and Feeding. 97 

the milk, they will affect the child's bowels and add to the 
existing trouble. 

On the contrary, if the child is suffering from constipa- 
tion, and the mother's bowels are costive, a laxative taken by 
her will have a beneficial effect upon the infant. 

If the mother has a return of her monthly periods soon 
after confinement, she will probably find that a little while 
before the return of her sickness and during its continuance, 
the child was fretful and its discharges frequent and watery 
in character. In such cases she should let the child nurse 
but little at a time, and not too often; and in lieu of the part 
withheld she must give it artificial food until she is well, 
when she can let it take its usual amount of breast milk. 
In the course of two or three months the milk will cease to 
disagree with the child and it can then take the breast with- 
out interruption. 

If, while nursing, the mother becomes pregnant, and there 
are evidences of her milk disagreeing with the infant, it 
should be weaned at once. 

Some women, to avoid becoming pregnant, continue nurs- 
ing their children long after the proper time for weaning 
has passed. This is a bad practice and should not be pur- 
sued, as the health of both mother and child may become 
impaired thereby. 

Irregular nursing should also be avoided. Not only must 
the child's stomach have sufficient time to digest the milk 
it contains, but it should also have a period of repose be- 
fore its powers are again taxed. 

A child that is feverish from any cause will desire to take 
its mother's breast very often; if this is permitted, it will 
be but a short time until a trifling ailment may become a 
serious disease. 

Instead of allowing the child to take the breast as often 
as it desires, the mother should restrict its nursing to proper 
7 



98 The Mother's Hand-Book. 

periods, and assist in allaying the thirst by frequently giving 
it small quantities of cold water — from a teaspoonful to a 
tablespoonful at a time. 

As before stated, it maybe two or three days after the 
child's birth before the mother's breast contains any milk. 
But this should not prevent the nurse from placing the 
child to the breast several times a day, as by so doing the 
secretion of milk will be hastened. But if the child obtains 
no nourishment from this source, it will be necessary to 
feed it artificial food until the mother gives sufficient milk 
for its wants. 

It has been estimated that from a quart to three pints of 
mother's milk a day is sufficient for a young infant. If this 
be taken at intervals of two or three hours during the day, 
and half as often during the night, the amount taken at one 
time is not great. Most children suckle too much at a time, 
and, as a result, suffer from indigestion. 

The quantity and quality of milk given by mothers differ 
in many instances. Some give a sufficient amount that is 
rich and possesses all the ingredients necessary for the 
growth of the child, while others secrete but a small quan- 
tity, which may or may not be up to the proper standard of 
richness. Others secrete a large amount, far in excess of the 
child's wants, but of a poor quality, the watery element being 
in excess. Those infants who draw their nourishment from 
healthy mothers, whose milk is rich in all the elements 
needed to nourish the child, will be in a condition most fa- 
vorable for rapid growth and good health. 

The old maxim that the " mother's milk is the natural 
(best) food for the child " applies to such cases. But chil- 
dren who draw their sustenance from mothers whose milk 
is deficient in quantity, or poor in quality, may require addi- 
tional food for their subsistence. Whether it will be best to 
wean them entirely, or let them get part of their food from 



Nursing and Feeding. 99 

the breast and the balance by artificial feeding, will depend 
altogether on circumstances. 

If the mother's milk be secreted in large quantities, and 
yet so poor in quality that the infant does not thrive on it, 
it is best to withdraw the child entirely from the breast and 
trust wholly to artificial feeding. But if the quality of the 
milk be good, yet the quantity be insufficient for its suste- 
nance, the child should continue to nurse, and the deficiency 
must be made up by artificial food. 

Something can be done by means of treatment to mode- 
rate the quantity, and improve the quality, of milk secreted 
by mothers who are not able to properly nourish their chil- 
dren, notwithstanding the flow is in excess of the usual 
amount. In the first place they should avoid as much as 
possible, all those fluids that have a tendency to increase 
the quantity of milk — for instance, beer, ale, porter, wine and 
various kinds of soups. Good, wholesome animal food, eggs, 
butter and like articles, tend to improve the quality of the 
milk. 

Where the amount of milk secreted is too small, but of 
rich quality, the administration of fermented drinks will 
often be advantageous. Ale, beer or porter can be used, 
to be taken with the meal. The various preparations of malt 
are also useful in such cases. 

The mother can also drink plentifully of cold water ; that 
obtained from wells being preferable to cistern water, owing 
to the salts contained in it, which are needed to produce 
healthy milk. Attention should be paid to the state of the 
bowels, and if they arc inclined to constipation, an occa- 
sional dose of mild aperient medicine will be beneficial. 

While it may be necessary to put the child to the breast 
as often as every two or three hours throughout the daytime, 
it will be sufficient to let it have its meal only every three 
or four hours during night. The, practice oi' letting the 



100 The Mother's Hand-Book. 

infant nurse each time it cries should be avoided; other- 
wise the mother will be deprived of needed rest and sleep; 
for the child will become more and more exacting as it 
grows older, and its constant nursing will keep up a drain 
upon her nervous system and cause her rest to be fre- 
quently broken. A child that is allowed to take the breast 
at will is a constant annoyance and trouble during the 
necessary temporary absence of its mother; besides, its 
stomach will have but little time for rest. The nourish- 
ment taken at one nursing should undergo a process of 
digestion and pass into the intestine, so that the stomach, 
being empty for a while, may cause a desire for more food 
before it is again put to the breast. This requires about two 
hours, and if that time be prolonged somewhat, it will be 
better for the infant. If the child nurses too often, it will 
tax the stomach beyond its power of digestion, and colic will 
be almost sure to result. 

As the child grows older, the interval between meals may 
be lengthened, so that at six months of age it should take 
the breast once in every three or four hours during the day- 
time. The hours for nursing here given are adapted to most 
cases ; but there are many exceptions, and as no general rule 
can be applied to every case, much will have to be left to the 
mother's good sense in this matter. 

Young children often throw up a portion of the milk that 
they have swallowed. When this occurs soon after nursing, 
it is merely an indication that too much has been taken, 
and that the stomach is unable to contain the whole amount. 
When this condition is present the child should be removed 
from the breast before it has taken its accustomed amount of 
milk*. If the practice of over-feeding be long continued, it will 
give rise to serious derangements of the stomach and bowels. 

While nursing her offspring a mother should not give way 
to her passions, but cultivate an even temper and gentle dis- 



Nursing and Feeding. 101 

position. It is well-known that a nursing child is easily 
affected by the mental condition of its mother. A sudden 
burst of passion, fright, or violent agitation will often pro- 
duce in the suckling babe diarrhoea, vomiting, convulsions, 
and even death. 

When from any cause it becomes necessary to take an in- 
fant from the breast and give it artificial nourishment, care 
must be exercised not only in selecting the proper kind of 
food, but also in the method of giving it. The child should 
nurse from a bottle, as this most nearly resembles the natu- 
ral method of taking its food. If fed from a spoon for a 
long time, it may refuse to take the mother's nipple after- 
wards; and in those cases where the child has been only 
temporarily weaned it may be almost impossible to induce 
it to return to the breast. When it refuses to take its nour- 
ishment in an artificial manner, the difficulty can sometimes 
be overcome by placing the bottle against the mother's breast 
so that the mouth-piece will be quite near her nipple. 

If, in spite of all these efforts, the infant still refuses to 
draw its milk from a nursing bottle, it will have to be fed 
from a spoon until, by continued efforts and the exercise of 
some ingenuity, the nurse succeeds in getting it to take its 
nourishment in the desired manner. In selecting a nursing 
bottle, those with long tubes should be discarded, for the rea- 
son that they are hard to keep perfectly clean. Bottles with 
a short neck, upon which is fitted a rubber nipple-piece, 
sufficiently perforated to permit the milk to flow freely, are 
the best. 

It should not be forgotten that nursing bottles require 
great care to keep them clean and pure, and if they are neg- 
lected, and any portion of decomposed milk is permitted to 
remain in them, it will usually produce sickness in the child. 
The bottle must not only be thoroughly washed in a strong 
solution of baking soda and warm water, but must also after- 



102 The Mother's Hand-Book. 

wards be well rinsed in pure water. This operation must be 
repeated each time after the child nurses. Such care involves 
labor, but there is no safety without it. 

The position of a child in nursing its mother is semi-erect; 
that is, its head and shoulders are slightly raised, so that its 
mouth may reach the nipple. When feeding a baby from 
the bottle the nurse usually lays it on its back, with its head 
sometimes lower than the stomach. This is wrong, as in 
this position the milk is liable to be thrown up and lost. 
It is best to place the infant on its side — the right being the 
preferable one — with its head and shoulders slightly raised, 
so that it can take and retain its food without difficulty. 

The proper preparation of artificial food for infants re- 
quires a great deal of care and skill. Milk forms the prin- 
cipal part of most infant foods, and none but a pure, fresh 
article, from a healthy cow, should be used. Such milk can 
usually be obtained by taking the time and trouble to secure 
it. For feeding very } 7 oung children, the milk from a cow 
whose calf is but a few weeks old is best ; but as the child 
advances in age this is not so important. The milk must be 
lately drawn from the animal, and to secure it fresh enough, 
the cow ought to be milked three times a day. The first 
milking should be at an early hour in the morning, for the 
child's forenoon food; the next at or about noon, to serve 
for the afternoon feeding; while the milk used through the 
night ought to be taken from the cow after dark. 

After the milk has been brought to the house, it should be 
kept in a cool, well-ventilated place. It must not be put 
into a damp cellar, or into a room where cabbage or other 
vegetables are kept, as it would absorb the odors from the 
vegetables, especially if they are undergoing decay. 

It is best to prepare the food ready for use as soon as the 
milk is brought to the house, for, after having been properly 
prepared, it will keep better than the milk before it has been 



Nursing and Feeding. 103 

heated. But if the milk he drawn from the cow three times 
a day, neither it nor the food will have to stand long before 
being used. Only enough food for the child to take at one 
meal should be put into the bottle at a time. After it has 
taken a sufficient quantity the bottle must be emptied and 
washed, to be again filled with fresh food when needed for 
the next meal. 

The most common substitute for mother's milk is fresh 
cow's milk diluted with water. Three parts of boiling water 
added to one part of cold milk will sufficiently scald the lat- 
ter without boiling it. If a little hulled barley be boiled 
with the water before adding it to the milk, it will be better 
than the water alone. This proportion is intended for in- 
fants under three months of age. After the third month, 
and up to six months, the proportion should be two parts of 
water to one of milk. From six months to one year equal 
parts of each can be used. After the child is a year old it 
will be sufficient to take one part of water to two parts of 
milk. In every case the water should be boiling hot when 
added to the milk, and contain a small amount of white 
sugar. The sugar should be used in minute quantities, 
however, or it may produce acidity of the stomach. About 
a gill of this mixture can be fed to an infant every two or 
three hours during the day. 

If the milk, prepared as above directed, does not agree 
with the child, the nurse may try the cream mixture made as 
follows: Take one part of fresh country cream and add to it ten 
parts of hot water, into which one even teaspooiiful of white 
sugar for each gill of water has been dissolved. This should 
be stirred until well mixed, and fed to the infant while warm, 
to the amount of a gill every two or three hours during the 
day. 

If diarrhoea follows the use of the milk or cream mixtures, 
it will be necessary to increase the relative amount o^ water 



104 The Mother's Hand-Book. 

until the mixture ceases to disturb the bowels. If the child 
continues to receive some nourishment from the mother's 
breast, the amount fed to it by artificial means must be 
decreased. 

A good substitute for the mother's milk during the first 
three or four months of infantile life is the common con- 
densed milk. It is prepared for use by adding one part of 
it to about twenty-two parts of water for an infant under 
three months; for a child over three and under nine months, 
about one part of condensed milk to eighteen parts of water; 
while for children over nine months of age the proportion 
should be one part of the milk to twelve parts of water. It 
can be given in the same quantities as the ordinary milk 
and water mixture. If after a fair trial the condensed milk is 
found to disagree with the child, some other article must be 
substituted for it. 

Reed & Carnrick, of New York, prepare a food for in- 
fants called Lacto-Preparata (prepared milk), which is well 
adapted to the nourishment of children under six months 
of age. Those children with whom the condensed milk dis- 
agrees will often thrive on Lacto-Preparata. It is also of ex- 
cellent service in many cases of digestive disorders where 
the ordinary food does not agree with the child. 

The various preparations of baked flour sold under the 
name of infant foods will often agree perfectly well with a 
child, and afford it all the nourishment needed for its growth. 
These foods, however, are not well adapted to an infant un- 
der four months of age; milk in some form being the only 
article suitable to give one so young. After the fourth month 
infant foods may be used in those cases where milk is not 
well borne. 

The packages in which " infant foods " are contained have 
printed on them full directions for preparing the food for 
use. But if diarrhoea is produced by the food prepared ac- 



Nursing and Feeding. 105 

cording to the directions given on the packages, it will be 
best to diminish the amount of milk entering into the pre- 
paration, using an equal amount of water in its place. Thus, 
instead of using one-third milk to two-thirds water, it might 
be well to use only one-fourth of the former to three-fourths 
of the latter. In some cases it is necessary to reduce the 
relative amount of milk still further. As the child gets ac- 
customed to the food, the milk can be gradually increased 
until the usual quantity is restored to the mixture. 

If the child's bowels become constipated while being thus 
fed, the quantity of milk can be gradually increased until 
they resume their healthy action. 

Usually about two ounces can be fed at a time, but in some 
cases a smaller quantity should be given. Like other arti- 
ficial foods it should be given in a warm state. 

The food must be prepared often, and with fresh milk. 
After its preparation it must be kept on hand only a few 
hours, and that which is to be used during the night must 
not be made until bed-time. The greatest care must be 
taken to keep the bottles, the tubes, and the vessels holding 
the food, sweet and clean according to the directions hereto- 
fore given. 

Persons living in the country, far away from drug-stores 
where infant foods are sold, can prepare a good substi- 
tute by using fresh cream crackers. Put them into a hot 
oven, brown them carefully without burning, then grate 
them into fine flour. Put a dessertspoon heaping full 
of this into eight tablespoonfuls of water and bring it 
to a boil, stirring the mixture the meanwhile. As soon 
as it begins to boil take it from the fire and add four 
tablespoonfuls of fresh milk and a little sugar. This can 
be fed in the same quantities as the milk and water mixture. 
If this food causes diarrhoea, less milk should be used in iis 
preparation and more water added ; but if the bowels become 



106 The Mother's Hand-Book. 

constipated from its use, the quantity of milk should be 
gradually increased until they are properly regulated. 

Sometimes the child, while taking artificial nourishment 
is attacked with vomiting and purging when the food does 
not really disagree with it, the trouble being caused by over- 
feeding. Instead of at once withdrawing such food, the 
mother should give much less of it at a time, and, if neces- 
sary, at shorter intervals. By pursuing this course, many 
cases that are at first troublesome will progress satisfacto- 
rily. In health, as well as in disease, the chiM's stomach is 
often overtaxed with food, causing vomiting and diarrhoea. 
By giving a smaller quantity at a time the difficulty is soon 
overcome and the child has no further trouble. 

The practice of adding lime water, bicarbonate of soda 
and other alkalies to 'milk before it is fed to an infant should 
be avoided if possible. It is better to prepare the food in 
such manner as will prevent it from undergoing acid fermen- 
tation than to endeavor to arrest such fermentative action by 
adding an alkali in advance of the feeding. Cases are some- 
times met with, however, where it seems necessary to add a 
small portion of lime water or soda to the milk before giving 
it to the child. 

Sometimes thickening substances, when added to the milk 
food, act beneficially by preventing the formation of large 
lumps of caseine. Of these, pearl barley water and gela- 
tine are perhaps the best. Barley water is made by boiling 
slowly two large teaspoonfuls of washed barley in a pint of 
water until it has been reduced to two-thirds of its bulk. 
After having been strained it can be added to the milk in 
place of water. 

To prepare the gelatine, put a piece of it, an inch square, 
into a teacupful of Cold water, and after letting it stand 
for three hours, place it into a sauce-pan with a sufficient 
amount of water, and boil until the gelatine is dissolved. 



Nursing and Feeding. 107 

When cold this forms a jelly, of which one or two teaspoon- 
fuls may be added to each bottle of milk food. 

Another article that is sometimes used in feeding in- 
fants is called "flour ball." To make this, take a pound of 
good wheat flour, and, tying it up tightly in a pudding bag, 
place it in a sauce-pan of water and boil for ten hours. 
When cold, remove the bag and cut away the soft outer cov- 
ering of dough that has been formed, and reduce the hard, 
baked interior by grating. In the powder thus obtained the 
starch has been converted into dextrine by the process of 
cooking. Reliance must not be placed on this article alone, 
but it may be used while a part of the child's nourishment 
is furnished by other foods. Only two meals of " flour ball " 
a day — one in the morning and the other in the afternoon — 
should be given. To prepare these meals rub one teaspoon- 
ful of the powder with a tablespoonful of milk into a smooth 
paste; then add a second tablespoonful of milk, constantly 
rubbing until a cream-like mixture is obtained. Pour this 
into eight ounces of hot milk, stirring it well, after which it 
is ready for use. If the child is under twelve months of age, 
the milk should be diluted by the addition of one-third its 
quantity of boiling water. 

If the child's bowels are constipated, the " flour ball " 
should be made of coarse flour; but if there is a tendency 
to diarrhoea, a fine article of bolted flour must be used. 

As before stated, the milk used in feeding infants should 
usually be scalded but not boiled. There are exceptions, 
however, to this rule. Persons living in large cities cannot 
be sure that the milk furnished them is obtained from a 
healthy cow. Indeed, it may be taken from a decidedly tu- 
berculous animal, and to give such milk without first boiling 
it might produce tuberculosis in the infant. It is at least 
certain that a child cannot thrive on tuberculous milk, 
and hence it is best, in all cases where the milk is obtained 



108 The Mother's Hand-Book. 

from a doubtful source, to boil it before mixing it with 
water or the various artificial foods. 

In some of the children's hospitals the milk fed to infants 
is first sterilized by heat in order to destroy the diseased 
germs that may be present; but the process is somewhat 
complicated, and, therefore, it will not be described here. 
Milk that has been boiled for five minutes will be sufficiently 
sterilized, and if the directions for infant feeding given in 
this book are strictly followed, the mother will usually have 
but little difficulty in selecting a food that will agree with 
her child. 

As the child grows older, it can be allowed other articles 
of diet besides the infant food. After the eighth month, 
farinaceous articles that are easily digested can be given. 
Some light vegetables may also be allowed; but in making 
trial of these the nurse must be on the watch, and if the 
stomach and bowels become deranged from their use, they 
must be discontinued at once and the child confined to its 
former diet. 

All kinds of meats had better be kept from the child until 
it is a year old. After this period tender meats may be cau- 
tiously fed to it, carefully watching the effects of such food 
on the bowels, and if any disturbance of those organs should 
arise, the meat must be withdrawn from the diet. 

The rules above given are general in character, and will 
apply to a majority of cases. Children vary greatly in their 
ability to digest certain foods ; an article that disagrees with 
one may be well borne by another. 

The intelligent mother will soon learn the particular kind 
of food that best agrees with her child, and if she proceeds 
cautiously in feeding untried articles, carefully watching 
their effects, and promptly withdrawing them when they 
disagree, she will usually be able to avoid making serious 
mistakes. 



CHAPTER VII. 



itUvnihig th* <fcf|U&> 



AT the time of weaning, disorders of the stomach and 
bowels are quite frequent, being caused, in many cases, 
by improper food, or by over-feeding, or by weaning too sud- 
denly or too early. 

When it becomes necessary, from any cause, to wean a 
child soon after birth, some difficulty may be expected in 
selecting a food that will agree with it, and at the same time 
afford enough nourishment for its proper growth. It will 
often tax the knowledge and ingenuity of both the mother 
and the physician to find a food that will suit each case, 
for that which agrees with one may not be suitable for an- 
other. All artificial foods, unless properly prepared, usually 
disagree with a child, and before rejecting them as unsuit- 
able it is well to change the method of preparing them. Too 
much importance cannot be attached to this subject, and that 
mother will succeed best in rearing her child, and in saving it 
from pain and disease, who has the most skill and patience 
in selecting and preparing its food, and uses the best judg- 
ment in its administration. 

When very early weaning is necessary, the mother may 
expect her child to suffer somewhat from stomach and bowel 
complaints. The change from natural to artificial food in 
one so young is usually followed to some extent by troubles 
of the digestive organs. If a good, healthy wet-nurse can 

[109 J 



110 The Mother's Hand-Book. 

be found, all may be well, but the difficulty of securing such 
a nurse, especially in rural districts, renders artificial feed- 
ing compulsory in most cases. 

When possible, a child should be gradually weaned. 
While a sudden substitution of artificial food for the mo- 
ther's milk will, in nearly all cases, produce disorders of the 
stomach and bowels, it often happens that a gradual wean- 
ing and blending of natural with artificial food is productive 
of no serious inconvenience. 

No specific time can be given when children should be 
weaned. If the mother's health is good, and the child is 
thriving on the breast milk, showing no signs of sickness, 
it may be best to let it nurse until it has passed its second 
summer. In these cases, however, the child should partake 
of a mixed diet after about the seventh or eighth month. 

When the mother's health is impaired, or when her milk 
does not agree with the infant, it may have to be weaned at 
a much earlier period. This can usually be done with safety 
if due care is observed in selecting a proper substitute for 
the mother's milk. 

A child that has been healthy from birth, and has nursed 
its mother constantly, may, at about the seventh or eighth 
month, commence to eat a little bread, cracker, or other 
farinaceous article, if such food is found to agree with it. 

Gradual weaning, which is really much safer than tak- 
ing the child from the breast suddenly, can be accom- 
jDlished in four or five weeks. Thus, during the first 
week the mother can give her child one meal of artificial 
food and six nursings daily; during the second, two feed- 
ings and five nursings; during the third, three feedings and 
four nursings; during the fourth, four feedings and three 
nursings; and during the fifth, five feedings and one nurs- 
ing. After this the breast milk can be entirely withheld, 
and the number of articles given the child can be increased, 



Weaning the Child. Ill 

taking care to notice the effect of each kind of food upon 
its health; and if diarrhoea or colicky pains result, the article 
that produced them should be withdrawn. 

It should be remembered that with children as with grown 
people, certain articles of diet that agree with some may not 
be borne by others. Therefore the mother should carefully 
watch the effect of the food given her child, rejecting that 
which disagrees and adhering to that which suits its diges- 
tion. 

In selecting food for a child its tastes and desires should 
be consulted to some extent. Other things being equal, a 
dish that is desired, and for which the person has an appe- 
tite, is much easier of digestion than one the thought of 
which is revolting. 

No one can specify with certainty the particular articles 
that will be best adapted to each individual. The most that 
can be done is to designate certain classes of food from 
which the mother can make a selection that will be best 
suited to each case. Among the articles that she can select 
from may be mentioned milk, bread, potatoes, fresh butter, 
rice, soft boiled eggs, broths, and after the twelfth month, 
meats of various kinds, either roasted or broiled. 

It sometimes happens that fat bacon, when thoroughly 
boiled, will agree with a child, even though suffering from 
diarrhoea, especially if it be of long standing. It does not 
agree in all such cases, and when given under these cir- 
cumstances the effect must be carefully watched, and if it 
causes trouble, it must be withdrawn without delay. It 
should never be given to a child With acute diarrhoea, hut 
only when the disease lias been of long standing and there 
is great emaciation and an absence of fever. 

During warm weather fruits should be sparingly given — 
if at all — as they tend to produce diarrhoea in very young 
children; but during winter baked apples or stewed prunes 



112 The Mother's Hand-Book. 

may be cautiously given. Raspberries, blackberries, and 
strawberries should not be allowed, even if cooked, as the 
seeds will likely cause diarrhoea; but these fruits may be 
cooked and the seedless pulp and the juice fed to healthy 
children in small quantities. During the warm months ba- 
nanas, and even oranges, had better be kept from the child, 
as they sometimes produce disturbance of the stomach and 
bowels. 

Only liquid food should be given late in the day, or at 
night, as solid articles eaten shortly before bedtime will 
greatly disturb the child's rest. 

After a child has begun to eat, it must not be confined to 
one or two articles, but its breakfast, dinner, and supper should 
consist of different kinds of food. Children should be fed at 
regular intervals,, and the practice so commonly in vogue of 
allowing a child to eat whenever it pleases, should be avoided. 

All articles of diet ought to be prepared with great care 
and in such manner as will render them palatable and easy 
of digestion. 

Children should be taught early that they must not have 
the kind of food eaten by older persons. The prac- 
tice of permitting little children to come to the table and 
eat anything that they may cry for is objectionable. They 
are almost certain to crave some article that is unsuited to 
their digestion, and the mother, in order to get rid of their 
importunities, is apt to yield to their demands. By proper 
training at an early day they can be taught to be content with 
such articles as their parents may think best to give them. 

For drink, the child can be given cow's milk if it agrees 
with it; but if it disturbs the stomach or bowels, a mixture, 
consisting of one part of fresh milk and two parts of boiling 
water, to which a little sugar has been added, may be tried 
as a substitute. This will usually agree quite well, even in 
warm weather. 



Weaning the Child. 113 

The mother, having gradually accustomed her child to the 
use of different articles of food, will have no difficulty in re- 
moving it from the breast and placing it entirely on a mis- 
cellaneous diet. 

When a child is troublesome to wean, being indisposed to 
give up the breast, the mother may wet her nipples with a 
decoction of aloes, or some other bitter substance, before let- 
ting it nurse. It will soon become disgusted with the taste, 
and will refuse to nurse any longer. 

Causes that may lead to Early Weaning. — In some cases, long 
before the usual time of weaning arrives, the mother may find 
it necessary, owing to some disease affecting herself or the 
infant, to remove the latter from the breast. 

First. The mother's breast may become inflamed, leading 
to an abscess, and sometimes to the drying up of the milk. 
If only one breast be inflamed, the child can nurse the 
healthy one, and any deficiency in the amount of milk can 
be supplied by artificial food; but sometimes, though rarely, 
both breasts become inflamed, in which case the child must 
be weaned, at least temporarily. Of course, the milk from 
an inflamed breast is not healthy, and the child should 
not be permitted to take it. Oftentimes the milk does not 
dry up in a gathered breast, or, if it does, it may return ; 
and in either event the child may again nurse wdien the 
breast has healed. 

Second. In cases of nursing sore mouth, it may be ne- 
cessary to wean the child in order to protect the mother's 
health, and possibly to save her life. Severe cases of this 
disease are impossible of cure as long as the child nurses ; 
but after the milk has dried up, and the system is no 
longer taxed with its secretion, the disease usually yields 
readily to suitable treatment. 

Third. When the mother's health is bad from any cause, 
and when continued nursing may endanger her life by its 



114 The Mother's Hand-Book. 

weakening effect upon her system, the child must be re- 
moved from the breast at once. 

Fourth. The child must be weaned without delay when it 
is found that the breast milk persistently disagrees with it. 
Sometimes the appearance of the menses will render the 
mother's milk unwholesome. Pregnancy produces such a 
change in the milk as to render it -unsuitable for the child, 
and under such circumstances it should be taken from the 
breast. 

Fifth. When the child is seized with cholera infantum or 
summer complaint, and when vomiting and diarrhoea are 
persistent, it is often advisable to wean it at once. This 
weaning may be only temporary, for after the child recovers 
to a great extent from the disease, it may again be put to 
the breast, the mother in the meantime having her breast 
drawn to prevent her milk from drying up. 

It is usually taught that the best nourishment for a child 
with summer complaint is its mother's milk. This, how- 
ever, is in many cases erroneous. 

When the child is very sick, the mother becomes alarmed; 
she loses sleep, and her nervous system is greatly deranged, 
seriously affecting the quality of her milk, and rendering it 
poisonous to the infant, thus causing a continuance of the 
vomiting and diarrhoea. If a healthy wet-nurse can be found, 
who has but little interest in the life of the infant, and whose 
milk therefore is not affected by its sickness, it will be best 
to place the child to her breast; but in the absence of such 
a nurse, recourse must be had to properly prepared artificial 
food. Of course artificial feeding, to be successful under 
such circumstances, must be conducted with the greatest 
possible care. 



CHAPTER VIII. 



fltjStcne of <£^il&r£tt+ 



KINDNESS TO CHILDREN. 

THE best method of rearing children is a problem that 
has vexed the minds of many parents from the earliest 
ages to the present time. Whether it is best to follow the 
advice of the wise Solomon and use the rod frequently, or to 
trust to persuasion and kindness, is a question that would be 
answered differently by different persons. 

The probabilities are that all children cannot be best con- 
trolled by the same methods; but it seems very doubtful to 
the writer that any child was ever improved in conduct 
and morals by means of physical punishment. It is true 
that the fear of such punishment may in some cases deter a 
child from an open violation of its parent's orders; but while 
the act may be restrained, the desire is not overcome. 

Children are sensitive to a high degree, and matters that 
seem trifling to grown persons are often of enough impor- 
tance to cause the little ones hours of unliappiness and mis- 
ery. A scolding, an unkind word, or even an ordinary re- 
mark given in a harsh tone of voice, may be sufficient to 
wound the feelings of a young child and make it shed tears 
of sorrow. 

A child that persists in being bad when surrounded at all 
times by kind and loving influences must indeed be o( 

[115] 



116 The Mother's Hand-Book. 

vicious stock, and whether under such circumstances physi- 
cal punishment would, in the least degree, tend to purge the 
blood of hereditary influences, is, to say the least, doubtful. 

As parents grow older they become wiser, and the writer 
has known many who in their old age deeply regretted that 
in their earlier days they had been in the habit of inflicting 
physical punishment upon their children for disobedience. 

Harsh treatment not only ruins the disposition of a child, 
making it disagreeable and morose, but in some cases health, 
and even life itself, is sacrificed by well-meant but injudi- 
cious and improper punishment. An instance came under 
the writer's observation many years ago, when a bright ner- 
vous boy of tender years and delicate frame, for a misdeed 
that would have been excused by a wise and loving parent, 
was subjected at school to such punishment and mortifica- 
tion as produced inflammation of the brain and death. 
Instances have been recorded where children, to avoid pun- 
ishment, or while laboring under the mortification of having 
been improperly punished, have taken their own lives. 

Good advice and kind remonstrance on the part of a par- 
ent has a more restraining influence than ever existed in 
whips or switches. Good advice, however, is to a great ex- 
tent impotent unless backed by good example on the part of 
the parents. A boy usually considers himself privileged to 
follow the example set by his father. How inconsistent, 
then, to expect the son to be truthful, honest and upright in 
his conduct when the father is guilty of falsehood, dishon- 
esty and immoralities! Or how can a mother, who on the 
least provocation indulges in fault-finding, scolding and 
abusive language to a daughter, expect that daughter to 
become affectionate, good-natured and amiable? 

Kindness to children, with proper regard for their happi- 
ness and pleasure, as well as sympathy for them in their 
troubles, is not only necessary for the highest development 



Hygiene of Children. 117 

of their mental and moral nature, but it also has an impor- 
tant bearing on their physical welfare. 

A mother who is devoted to her children, and watches 
over them with an eye the light of which is kindled by the 
llame of maternal love, will always be on guard to protect 
her offspring from disease and injuries. Their least ailments 
are noticed, and loving hands administer to their relief. 

To rear her child in such manner as will best secure its 
physical, mental and moral welfare, is her chief ambition. 
To this end she bends her best energies, and day and night 
her watchful care is over her loved one, being buoyed up by 
the hope that in adult life her child will be perfect in its 
physical development and sound in its mental and moral 
faculties. In short, she hopes that the old adage, "Mens 
sana in corpore sano " (a sound mind in a sound body), may, 
in truth, be applied to the object of her affection. 

THE DWELLING. 

In the country, the dwelling-house should be placed on 
elevated ground, so as to have the advantage of surface 
drainage.. If a few large shade-trees are in close proximity 
to it they will serve to keep off the sun's rays during the 
warm days of summer. 

If the site be an agreeable one, and if the house itself be 
built with due regard to appearances — having some orna- 
mentation about it — the family will be happier and more 
contented than if their dwelling is devoid of those adorn- 
ments that are necessary to render country homes pleasant 
and desirable. If to such a place are added well-arranged 
and carefully-kept grounds, filled with evergreens, shrub- 
bery and flowers in their season, a home will be created to 
which children will become strongly attached. 

Every dwelling ought to be constructed with a view of 
enabling its inmates to enjoy good health. The foundation 



118 The Mother's IIand-Book. 

should be placed on dry ground, and there should be no wet 
cellar under the building to breed disease and pestilence. 
If a cellar is built under a dwelling it should be cemented 
and kept dry. It is best to have the cellar placed under 
that part of the house not occupied by the family for living 
or sleeping purposes. Decaying vegetables and other refuse 
matters are prolific breeders of disease, producing germs that 
tell fearfully on the health of those living over or beside 
them. Too much care cannot be taken in keeping cellars 
dry, and cleaning and disinfecting them with lime at fre- 
quent intervals. 

No cess-pools should be allowed near the house. The 
laundry suds and refuse water from the kitchen should be 
deposited at some distance from the dwelling and disinfected 
during the summer months. 

Privies must not be permitted to become offensive ■; the 
vaults should be deep, and during hot weather their con- 
tents ought to be frequently disinfected with a solution of 
copperas. 

The inside of the dwelling should be arranged with a view 
to health as well as to comfort. But few houses in the country 
are heated by means of a furnace and hot-water or hot-air 
pipes. Too many of them are warmed by the use of closed 
stoves, which provide no means for ventilation. Such stoves 
are nighty objectionable, not only because of their lack of 
ventilating qualities, but also for the reason that a room 
thus heated cannot be kept at an even temperature. The 
open fire-place, or a grate, is preferable to all other means 
of heating a dwelling, but if stoves must be used, they 
should be of the open-faced or Franklin pattern. 

The practice of placing water-closets in the body of dwell- 
ings, so common in our large cities, is fraught with the 
greatest danger to the health and lives of those who inhabit 
such houses. No matter how carefully and skillfully con- 



Hygiene of Children. 119 

structed the plumbing may be, some of the gases may es- 
cape into the house. Persons subjected to the breathing of 
such mephitic gases are liable to suffer from typhoid fever, 
diphtheria, and kindred diseases. 

In all cases the water-closets ought to be placed outside of 
the main portion of the house. An ell can bo constructed 
with a transverse hall-way — with windows having movable 
sashes at each end — dividing the main building from the 
rooms containing the water-closets. By keeping the win- 
dows at each end of the hall slightly open, sufficient air will 
be admitted to carry off all poisonous gases and prevent them 

from entering the living apartments. 

i 

i 

THE SCHOOL-HOUSE. 

Diseases of various kinds are often contracted in school- 
rooms. In the country, school-houses are not infrequently 
heated by means of closed stoves, and as a result the air be- 
comes dry and often over-heated. The temperature is sub- 
jected to sudden and great variations, being at times en- 
tirely too warm, while at others it is so cool that the pupils 
complain of the chilliness. If a stove is used, one with 
an open face should be selected. By paying careful at- 
tention to the heating of such a stove, and to the proper 
ventilation of the room, the air may be kept pure and 
healthy. 

Ventilation can be secured by slightly dropping the sash 
of two or three windows on one side of the room. If win- 
dows on both sides be lowered, a Current of air will pass 
through the room, rendering the pupils liable to take cold. 

In man} 7 places, school-rooms are allowed to become too 
warm. The children soon begin to perspire freely, and 
going out into the cold air, they become chilled. Such 
exposure often produces colds, bronchitis, or pneumonia. 
Much of the sickness among children in country districts 



120 The Mother's Hand-Book. 

during the winter season is chargeable to the extreme heat 
and bad ventilation of school-rooms. 

In cities the school-buildings, although by no means per- 
fect in this respect, are better heated and ventilated than 
they are in the country. Some of the children are often 
placed too near the heating apparatus, and as a result be- 
come so warm as to perspire freely. They then go out into 
the open air, where the perspiration is suddenly checked, 
causing, in many cases, affections of the air passages. 

Sometimes, when the air becomes too warm, or too close, 
a window is raised for ventilation, and those pupils who sit 
near it are apt to take cold from the current of cold air that 
enters through the raised window. 

A thermometer should be placed in every school-room, 
and the teacher should see that the temperature is kept be- 
tween 65° and GS°. If this were done, a prolific source of 
disease among children would be avoided. 

Contagious diseases are often contracted in the school- 
room. If a child becomes sick with scarlet fever, measles, 
or other contagious disease, there is danger that other chil- 
dren in the room will suffer from the contagion. A strict 
enforcement of the rules adopted by the health departments 
of our cities, together with care on the part of parents not 
to send their children to school when out of health, are the 
safeguards against the dissemination of contagious diseases 
among school-children. 

The health of many children is seriously impaired — some- 
times permanently — by over-taxing their brains with too 
many or too hard studies. Parents are often to blame in 
this matter — their vanity leading them to encourage their 
children to undertake advanced studies before their minds 
are sufficiently matured to grasp them. 

The practice of frequent examinations at school should 
be discountenanced. Pupils often worry and fret over such 



Hygiene of Children. 121 

examinations until they are made nervous and sick. Girls 
are especially liable to suffer from these causes, and in some 
instances their health is permanently impaired. Instead of 
developing into healthy, robust women, they become weak 
and delicate creatures, and suffer from various kinds of ner- 
vous complaints. 

BATHING. 

A child should be bathed every morning during infantile 
life, by placing it in a vessel of water and thoroughly wash- 
ing it. If properly done, there is no danger of its taking 
cold, and in this manner the body can be cleansed in a short 
time. Of course, the temperature of the room should be 
carefully regulated, and no draught of air must be permitted 
to pass over the child. 

Occasionally, however, children are afraid of being dipped 
into water, becoming greatly alarmed at the process, and ex- 
pressing their fears by frightful screams. Sometimes a 
child's fear of the bath can be overcome by wrapping it 
in several thicknesses of soft flannel and gently placing it 
into the water. By this method, the wrappings become grad- 
ually soaked with water and there is no shock communicated 
to the child, as is the case when, in a naked state, it is sud-, 
denly plunged into the bath. 

When for any reason it is not advisable to place the child 
into a vessel of water, the sponge bath must be resorted to 
as a substitute, and although not equal to the former method 
of bathing, yet it will serve to keep the skin clean, ami. 
if carefully done, there is no danger of the child taking cold 
from the sponging. 

In using bot'h the dip and the sponge bath, the nurse 
should sec that the bathing is done quickly, and that the 
naked body of the child is exposed to the air but for a mo- 
ment. When taken from the bath it must be immediately 



122 The Mother's Haxd-Book. 

enveloped in a warm, dry blanket, and thoroughly dried with 
a soft cloth. 

If the sponge bath be used, the child must be covered 
with a fold of the blanket and only so much of its body ex- 
posed at a time as is undergoing the process of sponging. 
The nurse should use a soft sponge and the best castile soap. 
But, above all things, the room must be comfortably warm 
and no current of air permitted to pass through it. 

During the first months of infantile life, the temperature 
of the water should be a little above blood heat ; but as the 
child grows older, the temperature can be gradually reduced, 
so that after the ninth month the bath need not be warmer 
than its body. 

Some physicians recommend that cold water' be used for 
bathing younsr children; but in some cases it is certainly 
hazardous, and, in the hands of careless or inexperienced 
persons, may be quite dangerous. 

It is doubtful if, in ordinary cases, cold baths offer any 
advantage over warm ones, and they are surely not so safe. 
If cold baths are used in infancy they should always be 
given under the direction of a physician, who should see 
that his instructions are strictly obeyed. 

The belief entertained by some nurses that a cold bath 
each day is necessary to " harden " a child's constitution is 
not only erroneous but dangerous if carried into practice. 
While it is possible that children who have been treated in 
that manner may be hardy and vigorous when they arrive 
at adult age, it proves by no means that the cold bathing gave 
them their hardiness, but rather that they were naturally 
vigorous infants; otherwise they would have perished from 
such a practice, for it is more apt to destroy than_to benefit 
infants that are naturally feeble and of delicate constitutions. 

In addition to the bath given each morning, when the 
stomach is empty (for a bath should not be taken soon after 



Hygiene of Children. 123 

a meal) the child should have a good washing at night be- 
fore it is put to bed. 

During the day, and in most cases at night, the diaper 
should be removed soon after it has become soiled with urine 
or discharges from the bowels, and, with a wet sponge, the 
parts should be well cleansed, and carefully dried with a 
soft cloth. Merely wiping the child with a part of the soiled 
diaper, as is often practiced, is not sufficient. Inattention to 
these matters will give rise to "chafings" and excoriations— 
a condition both troublesome and painful. 

The skin of a young infant is tender and sensitive, and 
the greatest care and gentleness should be exercised in dry- 
ing it after a bath. Rough, or too long-continued rubbing, 
besides being painful, may produce inflammation and erup- 
tions of various kinds. With a soft cloth of well-worn mus- 
lin, the nurse should quickly wipe the several parts of the 
child's body, which can be done under a light blanket by 
lifting the blanket with one hand, while the cloth, held in 
the other, is gently and smoothly passed over the body. 
After this has been done, the skin will still be damp, and 
hence another dry cloth should be used for the final drying. 

Care should be given to the arm-pits, groins and nates, 
which should not only be well dried, but, if the child be 
very fat, should be dusted with powdered starch, or " baby 
powder" contained in a muslin bag. 

In discharging these duties the patience of the nurse 
should never become exhausted; she should be gentle and 
kind, and should refrain from an exhibition of anger or im- 
patience. Rude shaking or jostling the child, as well as 
scolding or speaking in a -harsh voice, must not be counte- 
nanced. Rough jerking may do it bodily harm, while the 
angry expressions of the nurse, and the harsh tones of her 
voice, will soon be noticed, and the temper of the child may 
be sadly affected. 



124 The Mother's Hand-Book. 

SLEEP. 

During the first two months after birth a child ought to 
sleep by the side of its mother. Its feeble power of generat- 
ing heat, and its great susceptibility to the influence of cold, 
render this necessary. But if it is very restless, and its 
sleep is greatly disturbed, it will be best to let it lie beside 
some other female. Once or twice during the night, and 
early in the morning, it should be taken to its mother's side 
for the purpose of giving it the breast. 

A restless child will keep its mother from much needed 
rest and sleep, and for this reason it should be put in care 
of another female during the hours of the night, so that its 
mother may have sound, refreshing sleep, so necessary in 
her enfeebled condition. 

After a month or six weeks have elapsed, a child, if it be 
healthy, may sleep alone in a basket, cradle, or cot. 

Care must be taken that the child has enough, but not 
too much, light, warm clothing, and that the room is 
of a proper temperature, i. c, from Go° to 68°. "While cold 
rooms and all draughts of air should be avoided, an atmos- 
phere that is too warm is equally dangerous. In these mat- 
ters good judgment must be exercised, as a young infant has 
but little power to resist the effects of cold air, or to over- 
come the changes in the circulation produced by sudden 
transition from heat to cold. 

In young children the temperature falls from one to two 
degrees during the evening and night, the lowest being at 
about two o'clock in the morning. From this hour it begins 
gradually to rise. 

As the temperature of the body .during the night is natu- 
rally lower than it is during the day, it can be readily under- 
stood that the child should not sleep in a cold room, since its 
vital powers would be still further depressed, thus leading, 
in some cases, to diseases of a serious nature. 



Hygiene of Children. 125 

If draughts of cold air are allowed to pass over the child 
while sleeping, or if the temperature of the room is too low, 
or the covering insufficient, a severe cold in the head, or 
perhaps an attack of pneumonia, may result. On the other 
hand, if the room is too warm, or the covering of the child's 
■ bed too heavy, the same result will probably follow. 

Covering the child's face with a handkerchief or other ar- 
ticle must be avoided, as the nose and mouth should be ex- 
posed so that it can breathe pure air freely. 

Narrow cradles with high sides should not be used, for 
the reason that if the child lies upon its side there will not 
be sufficient room for it to breathe freely. 

For the first two or three years the child should lie upon 
feathers, and the most scrupulous care must be taken to 
keep the bed clean and dry. Frequent exposure of the bed 
and bed-clothes to the open air is necessary. 

During the whole period of childhood much more sleep is 
required than in adult life. From the second to the fourth 
year the child should sleep an hour or two before dinner, 
and from seven or eight o'clock in the evening until the fol- 
lowing morning. 

No precise rule can be given as to the amount of sleep 
that each child requires. Much will depend upon condi- 
tions peculiar to each one; but it is well to remember that 
infants pass the greater portion of their time in sleep, while 
older children sleep from twelve to fourteen hours during 
each day and night. The school-boy usually requires ion 
hours, while in youth most persons will sleep eight hours. 
In old age many do not sleep more than six hours. 

AV^ith children, as with adults, regularity in sleep is of the 
greatest importance, and the mother should permit nothing 
to interfere with it. The child ought to be permitted to 
awake of its own accord in the morning, after which it 
should not be allowed to lie in bed any longer. 



126 The Mother's Hand-Book. 

On no account should a child be suddenly or violently 
awakened; but if it be necessary to disturb its sleep, it 
should be done in the gentlest manner possible. 

A mattress is much better than a feather bed for a child 
to sleep upon after it has passed its third year. 

The bed, after a child has vacated it in the morning, as' 
well as the bed-clothes, should be thrown over a chair where 
they can be well aired, the windows being opened for that 
purpose and also to ventilate the room. 

Children should, if possible, sleep alone, and on no ac- 
count should a child be permitted to sleep with a sick per- 
son or with those who are far advanced in age. 

DRESS. 

A child's dress should be light, of easy fit, and warm 
enough to protect the body from the impression of cold. 
The body must be well covered, for to leave the neck, chest, 
arms and legs of a child bare is to invite disease and death. 
The material and quantity of clothes should be adapted to 
the season of the year and the physical condition of the 
child. 

While, therefore, the body of a child, including its neck, 
chest, arms and legs, is protected, it must not be too warmly 
clad by being enveloped in innumerable folds of clothing or 
kept confined in very hot and close rooms; for nothing so 
tends to enfeeble a child's constitution, to induce disease, 
and render the skin highly susceptible to the impressions of 
cold, as dressing it too warmly or confining it to rooms that 
are close and hot. 

In country districts mothers who visit their neighbors in 
cold weather often prepare the child for the visit by wrap- 
ping it in a shawl and a blanket, and perhaps also a bed- 
quilt or a bed-comfort. It has enough wrappings for two or 
three little ones, and when it reaches its destination and the 



Hygiene of Children. 127 

coverings are removed it is profusely bathed in perspiration. 
Often a sudden cold is developed, and croup or pneumonia 
results, while the poor mother wonders how the child could 
possibly have taken cold, as she had it wrapped up so very 
warm ! 

Instances of the kind have often come under my own ob- 
servation, and it has been very hard to convince the mother 
that she caused the child to take cold by putting too much 
clothing around it. 

In the early months of infantile life the skin is very deli- 
cate, and it will be best to put on a shirt of fine muslin (not 
starched) next to the skin, and over that should be worn a 
flannel garment. The outer dress may be of calico. 

After the child has become a few months old, and especi- 
ally if it be suffering from diarrhoea or other bowel troubles, 
flannel must be worn next to the body. In warm weather 
the thinnest and finest white flannel should be used; but in 
cold weather it may be thicker and warmer. 

The dress should be so made as to put no restrictions on 
the use of the child's limbs. It must fit easily and loosely, 
being large enough to afford room for growth, which in 
young children is rapid. The clothing must not fit tight 
around the neck, armholes, chest and wrists. It should 
be so made as to be easily taken off or put on, as dressing a 
child is fatiguing to it, and should be done quickly. Some 
mothers tack every part of the clothing that needs fas- 
tening with needle and thread, thus dispensing with the 
use of ordinary pins, which are apt to pierce the child's skin 
and cause pain. The patent safety-pins, however, are not 
liable to this objection. The diapers can be fastened with 
loops and tapes, and should be made of soft canton-flannel 
with a good nap on it. These will be soft and non-irritating, 
and if they be changed as soon as they are soiled there will 
be no danger of the child taking cold from their use. 



128 The Mother's Hand-Book. 

The clothing should be changed often. Cleanliness abso- 
lutely demands this, and it must be remembered that the 
wearing of soiled garments is productive of skin diseases of 
various kinds. 

If proper care is taken to prevent young infants from 
taking cold, and if the directions given in this book are care- 
fully followed, there will be no necessity for the use of caps; 
indeed, the probabilities are that there is more danger in 
the changing of caps, or in leaving them off at times, than 
in dispensing with them altogether. 

The dress in childhood should possess the same properties 
as in infancy. It should be warm, light, and so loose that 
no part of the child will be constricted by it. 

The whole body must be well covered, as by exposure of 
the neck, chest, arms or legs, the child is liable to contract 
croup, or pulmonary disease. Indeed, it is quite likely that 
the foundation for consumption is often laid in early child- 
hood by needless exposure of the arms and chest. 

The good sense of the mother will teach her that the child 
should be clad warmly in cold weather, and lightly in warm 
weather; but sudden changes from warm to light cloth- 
ing should not be made. The winter dress should be re- 
sumed early in cold weather and laid aside late in the spring. 

Healthy children can wear cotton goods next to the body 
during the warm months and flannel during the cold months. 
But if the child be sickly or disposed to consumption or 
scrofula, it must wear flannel next to the body at all seasons, 
except, as before remarked, when the flannel irritates the 
skin. In such cases a shirt of thin, fine linen can be worn, 
and over it the flannel garment. 

EXERCISE. 

After the close of the second month, if the weather is 
warm and dry, the child may be taken by the nurse into the 



Hygiene of Children. 129 

open air for a short time. The dress must be varied from 
that worn in the house, the head being covered, and the 
feet carefully protected from the cold. The nurse should 
take the child in her arms in such manner as to afford sup- 
port to the body and head. This plan must be adhered to 
until after the third month, when the child will be suffi- 
ciently strong to maintain itself in a sitting position. None 
but trustworthy nurses should be entrusted with this duty, 
as the most serious consequences may result from laying the 
child on the ground, or subjecting it to a draught of cold air. 
Placing the infant upright on the knee, and jolting it vio- 
lently up and down, as is sometimes done, may produce very 
serious results. 

If the child is born in late autumn or winter it will be 
best to wait until the warm weather of spring before taking 
it out into the open air. If the temperature and ventilation 
of the rooms have been properly attended to, no harm will 
result from deferring the out-door exercise. As the child 
grows older it may be placed in a baby carriage, on a com- 
fortable pillow, and wheeled out in the open air for a short 
time each clear, warm day. The face should be shaded, as the 
sun's rays are not only a source of discomfort and annoyance, 
but are highly injurious to the eyes. But carriages should 
be dispensed with if the child is not well — especially if it is 
suffering from bowel complaints. In such cases the out- 
door exercise must be taken in the arms of a careful nurse. 

During very warm days the open-air exercise must be 
taken early in the morning and just before night-fall. 

As a rule, no attempt should be made to teach the child to 
walk at a very early date, and the many contrivances made 
to accomplish this purpose are mischievous in their tenden- 
cies. The bones in early infancy are soft and bend easily if 
too much weight is placed upon them. Therefore, if the 
child is placed upon its feet too early, and kept in that posi- 



130 The Mother's Hand-Book. 

tion too long, the bones of the legs will bend under the 
weight, constituting the deformity known as "bow legs." 
In the same manner a bending or curvature of the spine 
may be caused by too early and long-continued attempts to 
teach a young child to walk. 

A child soon learns how to walk itself, and does not require 
to be taught. It first learns to crawl, thereby using most of 
the muscles of its body. This exercise does not fatigue it 
and does not throw undue weight upon the bones, but im- 
parts vigor and strength to the frame. After aAvhile it 
will endeavor to lift itself on its feet by the aid of a chair, 
and, although it will fail again and again, it will continue in 
its attempt to accomplish its purpose. Soon it will learn to 
stand by leaning against a chair, and after awhile it will bal- 
ance itself on its feet without touching any object. Next it 
will seize anything near it with its hands and take a step or 
two towards the object to which it clings. This will be re- 
peated, day after day, until it has confidence in its strength 
and ability to balance itself without support, when it will 
start off and run alone. If no improper articles are near it, 
and if its exercise is taken on a soft carpet, the few falls it re- 
ceives while learning to walk will be unattended with danger. 

Exercise during Childliood. — When a child has arrived at 
sufficient age to take open-air exercise without the supervi- 
sion of the nurse, it should be permitted, in Avarm, pleasant 
weather, to spend most of the day outside of the room. 
Out-door exercise, under these circumstances, will give it 
health and strength, and help to lay the foundation for a 
vigorous manhood or womanhood. To play in the open air 
is natural to children, and the mother who compels her child 
to remain in-doors when the weather is fair commits a grave 
error. 

During the winter season the child should be permitted 
to play out-doors at short intervals when the weather is fair, 



Hygiene of Children. 131 

care being taken that it is properly clad, and that its head 
and feet, as well as its body, are kept warm and dry. The 
practice often in vogue in country districts of permitting 
children to play ont-doors during cold weather without any 
covering on their heads is dangerous and should be 
avoided. 

If the child is delicate, and disposed to scrofula or ton- 
sumption, more care will have to be taken of it during the 
colcl season. It must have out-door exercise, but must not 
be allowed the same freedom in playing in the open air as 
a strong child. 

If the child's strength is not sufficient to enable it to 
take a proper amount of out-door exercise without assistance, 
its parents should take it out on horse-back or in a carriage. 
Good food, warm flannel clothing, and plenty of out-door 
exercise, will do much towards overcoming a tendency to 
scrofula and consumption in the young. 

The rules here given apply with equal force to girls as to 
boys. During childhood both sexes should have plenty of 
exercise, and, as a rule, parents sensibly permit their sons 
and daughters alike to' reap the benefits that are derived 
from playing in the open air. The unnatural restraint, both 
in exercise and dress, that is imposed upon girls by their 
foolish parents, begins after childhood has passed. 

As boys grow older they are apt to injure themselves by 
violent muscular exercise, and parents should caution them 
against this danger. 

While certain kinds of active exercise, if indulged in to 
a moderate degree, arc useful in building up the constitu- 
tion and giving tone and strength to the body, yet if carried 
beyond proper limits the most serious consequences may 
result. Professional rowers often fall victims to heart-dis- 
ease in early life, the strain upon the heart being so great as 
(o produce organic changes in its structure. 



132 The Mother's Hand-Book. 

Running and walking against time may also produce in- 
curable disease of the heart and lead to early death. Fast 
running may not only produce enlargement of the heart, 
followed by dilatation of the organ, but the lungs also are 
often injured by such violent exercise. Some of the air- 
cells may rupture, causing emphysema; or some of the ves- 
sels of the lungs may give way, producing hemorrhage or 
" spitting of blood." 

The game of foot-ball, unless moderately indulged in, is 
not without its dangers, and the American game of base-ball 
often leads to such changes in the heart and lungs as to be 
beyond all chance of recovery. 

When the heart is injured from over-exertion, it at first 
attains a large size and becomes irregular, if not intermit- 
tent, in its action. Sometimes, though beating regularly 
when the patient is at comparative rest, it assumes an inter- 
mittent action from the slightest physical exertion. 

Exercise, to be healthy, and taken for the purpose of 
giving tone and strength to the muscles of the body, must 
be moderate and not indulged in too long at a time. It 
should be of such a nature as will bring into play the various 
muscles of the body. To use only one set of muscles while 
exercising only partially fulfills the objects that should be 
attained. Skipping the rope and rolling the hoop are excel- 
lent exercises for young girls, while walking and light run- 
ning will add to their strength and endurance. 

For the weak and delicate there is no exercise equal to 
horseback riding, and a short ride, two or three times a day, 
on a gentle horse, will soon be productive of the best effects 
even in those who are debilitated from such wasting diseases 
as consumption and scrofula. 



CHAPTER IX. 



®ltfc Mother mt& the Pftgsictmu 



I SHALL not attempt to teach mothers how to prescribe 
for sick children to the extent of doing without the ser- 
vices of a physician. To do so would be to inflict a great deal 
of mischief on both mother and child. It requires years of 
study and observation to enable one to prescribe intelligently 
for sick children; and it is seldom that a mother should at- 
tempt to give medicine to her offspring except under the 
direction of one who is skilled in their diseases. 

In the trivial ailments of children, when it is not conve- 
nient to secure medical advice, a mother can, if properly in- 
structed, often assist in restoring her child to health with- 
out resorting to the use of active medicines. Also, in cases 
of accidents, such as burns, scalds, etc., it is very necessary 
that she should know how to proceed in taking care of the 
sufferers. 

Good nursing, proper feeding and ventilation are very 
important factors in the cure of sickness, and hence consid- 
erable attention has been paid to these subjects in these 
pages. 

Before entering upon the consideration of the diseases of 
children it is proper to treat briefly of the conduct of the 
mother towards the physician. 

As the mother and doctor are brought into such close rela- 
tions in the management of sick children, it becomes abso- 

[133] 



134 The Mother's Hand-Book. 

lutely necessary that the most perfect confidence should exist 
between them. Haying secured the services of the physi- 
cian in whom she can trust, it becomes the mother's duty to 
pay strict attention to his advice and directions, and on no 
account to substitute other remedies for those prescribed by 
him. She will often be beset by meddlers, who will advise 
her to use this or that remedy, on the ground that they have 
seen good results accomplished by it in similar cases. The 
absurdity of the argument that a remedy should be used be- 
cause it was seemingly successful in a similar case, is shown 
by the fact that no two cases are precisely alike. Symptoms 
are the result of diseased conditions of the body, and dis- 
eases of very dissimilar character may give rise to many 
symptoms that seem to be almost identical. In other words, 
a certain symptom may be caused by a certain disease in 
one case, while in another such symptom will proceed from 
an entirely different cause. Then, again, the constitutional 
peculiarities of the patient may render it inadvisable in one 
case to prescribe a remedy that in another would be bene- 
ficial. The observant physician carefully studies the per- 
sonal peculiarities of each patient, as well as the precise 
nature of the disease that he is called upon to treat, before 
he makes up his mind to administer any remedy. This re- 
quires a thorough knowledge of disease, as well as of the 
action of medicines, and no one unacquainted with these 
matters should assume the responsibility of prescribing for 
sick people if the services of one skilled in the treatment of 
disease can be obtained. 

If those who are ignorant of diseases and of the action 
of remedies would only reflect on the responsibilities they 
assume, and the great harm that may follow their well- 
meant but injudicious suggestions, there would be less in- 
terference by non-professional persons in the management 
of the sick than is now the case. 



The Mother and the Physician. 135 

Some persons will advise the mother to discharge the phy- 
sician in attendance and employ another who, they declare, 
has particular skill in such cases. No wonder that the 
mother becomes confused when surrounded by so many 
advisers, each one assuring her that unless a change of phy- 
sicians is made the child will die, and each one giving 
different advice. The best thing to do is to pay no atten- 
tion to any of them. The mother, having selected a medical 
attendant, should stand by her choice unmoved by those who 
have no special interest in the welfare of the patient and no 
ability to judge of the qualifications of medical men. In 
some cases it may be advisable to call into consultation some 
other well-informed doctor, but under no circumstances 
should the mother allow the advice of her visitors to have 
any influence with her in making a change of physicians. 
If a change is to be made, it should be solely on the respon- 
sibility of the parents, who have the most interest in the life 
of the child. If the medical attendant is an upright, hon- 
orable man, with good conscience and a broad view of his 
duties as a physician, he will, in all cases where he believes 
that such a course will be beneficial to the patient, suggest 
'the propriety of calling a consultant. 

I have often wondered how people, possessed of good sense, 
could take the responsibility of selecting a physician for 
others, and insist on his employment in cases already in 
charge of a medical man; or how it is possible that one 
knowing himself to be entirely ignorant of the science 
of medicine can advise that the medicines prescribed by a 
physician be set aside and others substituted in their place. 

If anything occurs during the sickness of a child to shake 
the confidence of a mother in the physician's skill or know- 
ledge of the case, the best course for her to pursue is to 
plainly and frankly state her fears to the doctor and ask for 
a consultation. No honorable physician can refuse such a 



136 The Mother's Hand-Book. 

request, nor can he justly censure the mother for her fears 
and anxieties. The physician has a right to demand fair 
and frank treatment, but he must admit the right of every 
mother to employ whom she pleases to attend upon her child. 

If a mother becomes dissatisfied with the treatment em- 
ployed during her child's illness, and instead of a consulta- 
tion she prefers that another physician shall have entire 
charge of the patient, she should so inform the medical 
attendant, who will forthwith retire from the case. 

It is often given as a reason for demanding a consultation 
that "two heads are better than one." This is usually erro- 
neous as applied to the treatment of a sick person. " No 
one dreams of trusting a ship to two captains, and I have not 
read that empires have ever prospered under several masters." 

In cases of grave diseases, where two or more physicians 
are in attendance, unless they are of one opinion on all mat- 
ters connected with the case (which rarely occurs), the re- 
sult is usually a vacillating course of treatment, and a shifting 
of responsibility from one to the other, to the patient's detri- 
ment. This is in striking contrast to the course pursued by 
the able and self-reliant physician, who, having sole charge 
of the patient, feels the responsibility that is thrown upon 
him, and who, in the presence of the patient or elsewhere, 
bears his case in mind, gives it his best thought, and bends 
every energy of his mind to- the accomplishment of a cure. 

Still, it is true that cases do arise where more than one 
physician is needed, but they are not common; and when 
they do occur the medical attendant will usually suggest the 
propriety of calling a consultant. 

In employing a consulting physician always select one 
that is on friendly terms with the medical attendant. To 
do otherwise may endanger the patient's welfare, for the 
reason that the physicians, being unfriendly, will not likely 
be in accord as to the best method of treating the case. 



The Mother and the Ppiysictan. 137 

The best plan to pursue is to select the physician of your 
choice, and when he has once taken charge of the case give 
him your full confidence, rely upon him, and let him know 
that you wholly trust to his skill. If you distrust him do 
not let him know it unless you have made up your mind to 
dispense with his services. Nothing embarrasses a true 
physician more than to know that his patient, or the pa- 
tient's relatives or friends, doubt his ability. It renders him 
vacillating, and robs him of that decision and prompt action 
which are so necessary in treating the sick. 

But few persons have any conception of the labor and 
anxiety connected with the practice of medicine. To get out 
of a warm bed and ride many miles in the country on a cold 
night is usually considered the greatest hardship that a phy- 
sician undergoes. But this, disagreeable as it is, does not 
constitute the worst phase of professional life. The worry 
and anxiety that are inseparably connected with the care of 
very sick patients render the physician's life one of constant 
dread and uneasiness, and deprives him of many of the 
pleasures enjoyed b} r those who pursue other avocations. 
Besides, he has no time that he can call his own. He is, to 
a great extent, deprived of the pleasures that grow out of 
social intercourse, and his attendance upon church and 
public amusements is liable to be interrupted at any time. 
When he has very sick patients under treatment, the ring of 
his door-bell startles him with the fear that some one is 
worse; and at each visit, when entering the house of the 
sick, he carefully scans the countenance of each one whom 
he meets, hoping to gain an index of the patient's condition. 

People sometimes put physicians to a great deal of un- 
necessary trouble, causing them to lose much valuable 
time. In case of an accident to some member of a fam- 
ily it is not uncommon to dispatch messengers to different 
physicians, with the request that they come immediately to 



138 The Mother's Hand-Book. 

the patient's assistance. The result is that perhaps three 
or four doctors hurry to the patient's house, when the ser- 
vices of one only are needed. Of course, those who are not 
needed return in bad humor, feeling that their time has 
been trifled with. 

When an emergency requires the prompt services of a 
physician it is best to dispatch a messenger for the family 
physician if he be near at hand; but if he cannot be had, 
the messenger should be instructed to call some other phy- 
sician. By trusting to one messenger, instead of sending 
two or three, but one medical attendant will be summoned, 
and much embarrassment and ill-feeling will be avoided. 

If the patient be suffering from dangerous hemorrhage 
(about the only kind of a case where immediate assistance 
is necessary to save life), some non-professional person can 
make pressure upon the bleeding point, or else use the tour- 
niquet as described in the chapter on hemorrhage, until the 
physician arrives. 

When two or more medical men are summoned to a case 
at the same time, the first one that arrives should have 
charge of the patient until the arrival of the family phy- 
sician, when the control of the case should be given to 
him. 

While a physician should cultivate a cheerful bearing in 
the sick-room, thus rendering himself agreeable and plea- 
sant to all with whom he comes in contact, he should never 
for a moment forget the dignity of the position he occupies 
and the great responsibilities that rest upon him. While it 
may be best to yield to a certain extent to the little whims 
and caprices of patients under some circumstances, his 
orders and directions should be insisted upon when there is 
any important matter at stake, and especially when the en- 
forcement of his instructions is necessary to the welfare of 
the patient. 



The Mother and the Physician. 139 

The physician should possess a discriminating judg- 
ment, coupled with a large amount of good common sense. 
He should he moral, upright and truthful — a man in whose 
word the most implicit confidence can be placed. He 
should be studious and attentive to his business, remem- 
bering that the practice of medicine affords an ample field 
for the exercise of all the mental faculties of even the most 
gifted. If to these virtues he has added a liberal education 
in his profession, and a proper amount of experience at the 
bed-side of the sick, he may justly lay claim to the title of 
a true physician — one in whose skill and knowledge the 
afflicted can trust in the darkest hours of pain and suf- 
fering. 

In all cases of sudden and severe attacks of sickness, a 
physician should be hastily summoned; but the mother should 
not become unduly excited and attach too much importance 
to the trivial ailments of her children. Upon her child 
showing a slight indisposition, a young and inexperienced 
mother often becomes greatly excited and immediately dis- 
patches a messenger for the family physician, bidding him 
come immediately, as the child is thought to be dying. It 
may be that he is engaged in the examination of a cas'e that 
will require some time to complete, but relying upon the 
truthfulness of the message sent him, he asks his patient to 
excuse him, making another appointment to complete the 
examination. When he arrives at the house to which he is 
summoned, he finds that there is but little the matter with 
the child, that his visit was unnecessary, and that his time 
had been trifled with. Of course, the mother tries to con- 
vince him that the child was dangerously sick, though better 
now. He goes back to his office in bad humor, and the next 
time he is summoned by the same mother he is not so 
prompt to obey; and there may come a time when he is 
really needed without delay, but having been so often de- 



140 The Mother's Hand-Book. 

ceived he does not believe it, and therefore postpones his 
visit until it may be too late. 

"It is not enough to have chosen a good physician, one 
who repays in cleverness and zeal what is accorded him of 
affection and trust: you must know how to make use of him. 
A physician, strong in his own convictions, and earnest in 
his work (and, very fortunately, there are many such), is a 
delicate creature to manage. He is easily exalted or cast 
down. A word of unmerited distrust draws him down from 
enthusiastic duty to mere duty; a word of trust and attach- 
ment increases his zeal tenfold. . . . Your doctor's care of 
you depends on yourself, be it remembered, and the best way 
(I will say the only way) of getting yourself well taken care of 
is by giving yourself up unreservedly to the one you have cho- 
sen, leaving to him the whole responsibility, without hinder- 
ing his action by any ill-timed and meddlesome interference. 

" An affectionate indulgence must be shown him ; he 
meets with so many dreary experiences in his career that 
he really has some rights of which he has reason to feel 
tenacious. . . . One specially important thing is not to 
abuse a physician and cool his zeal by trivial calls, thus 
running the risk of his indifference at a time when his ser- 
vices shall have become really necessary. Physicians are 
accused of being thin-skinned, and in a general way that is 
true enough. But in whom was it ever more excusable? 
The sensitiveness of mere self-love is puerile, and not worth 
talking about; but that which is rooted at the same time in 
scientific conviction, in a sense of responsibility, and in con- 
scientious anxiety, is worthy of consideration and needs 
careful management. A physician who is not sensitive is 
apt to be indifferent, and the mediocrity of his services off- 
sets his easy-going ways." 

A child's sick-room should be properly ventilated. Pure, 
fresh air in a room is always salutary; but currents of air 



The Mother and the Physician. 141 

must be avoided. Sufficient air from the outside can usually 
be secured by raising the lower sash of a window two or 
three inches and accurately fitting a board in the space be- 
low the raised sash. This arrangement permits the air to 
enter the room where the upper and lower sashes meet in 
the centre of the window. It is a good plan to have two 
rooms communicating with each other, keeping the door be- 
tween them open. The room occupied by the patient can 
then be ventilated by admitting fresh air into the adjoining 
one, thus overcoming any danger of producing currents 
near the patient's bed. 

Quiet is essentially necessary in a room occupied by a sick 
person. Loud talking, heavy walking, causing the room 
to shake, slamming of doors, and similar noises, disturb the 
patient and prevent sleep. Whispering, so frequently heard 
in the sick-chamber, constitutes one of the most annoying 
sounds that can fall upon the patient's ear. A. sick person 
should seldom, if ever, be aroused from a natural sleep. As 
sleep is a potent factor in the restoration of a diseased body 
to a condition of health, it is important not to interrupt 
nature's process of healing by waking those who are enjoy- 
ing the benefits of a calm slumber. 

The visits of friends to the sick-room should not be en- 
couraged. A good nurse to aid the mother in caring for the 
child is the only one whose attendance is advisable. Visit- 
ing friends can do no good, and usually do a vast deal of 
harm. They are prone to comment on the case, and often 
assure the mother that they have seen cases precisely like it 
which ended in death. Many such persons insist on giving 
some medicine, of the effects of which they are grossly igno- 
rant, in place of that prescribed by the doctor. It seems 
impossible for some persons to refrain from being meddle- 
some, and meddlesomeness always works injury to the pa- 
tient and brings misery to the mother. Therefore, the 



142 The Mother's Hand-Book. 

mother should insist on the exclusion of visitors from the" 
sick-room, so that quiet, which is a necessity even if the 
patient be an infant, may be secured. 

It often happens that great trouble is experienced in get- 
ting children to take medicine. If a dilly-dallying course 
be pursued, the child becomes exhausted by fretting and re- 
sisting the nurse's importunities to get it to take the medi- 
cine willingly. Sometimes deception is resorted to to over- 
come its scruples. The child is told that it is sugar or some 
other sweet substance, in order to get it to swallow a drug 
which may be bitter. This is wrong, and cannot be success- 
fully practiced a second time. The nurse should call things 
by their true names, and in no event try to deceive the 
child. The medicine should be given promptly and without 
much ado. To wait for a child to " make up its mind" to 
take it is useless; it never makes up its mind, and the 
struggles and worry that result from such a course tend to 
exhaust the patient's strength. Therefore, when the time 
comes to give a child a dose of medicine it should be 
given promptly, notwithstanding its indisposition to take 
it. If the child be old enough to understand the impor- 
tance of obeying the physician's orders, it may be best 
to kindly tell him that the medicine is intended to do him 
good, that the doctor prescribed it for him, and that if he 
will take it willingly the doctor shall be informed of his good 
behavior. By proceeding firmly and tenderly, but a few 
moments will be consumed in getting through with the dis- 
agreeable duty, and when once the dose is swallowed the 
child soon composes itself. No fear need be entertained 
that the child will become strangled by the medicine if pro- 
per care be taken in its administration. 

The nurse must be watchful of the symptoms and condi- 
tions of the child during the intervals between the physi- 
cian's visits, so as to give him a correct report upon these 



The Mother and the Physician. 143 

matters at each visit. It is not only necessary that he should 
see the condition of the patient at the time of his visit, and 
carefully note each symptom then present, but he must also 
have a knowledge of what has occurred during the time he 
was absent. For this information he must rely upon the 
nurse, who, if she has been observant, can readily answer 
his questions. 

The greatest care must be observed in feeding sick chil- 
dren. An error made by giving indigestible or otherwise 
improper food may of itself be the cause of death in some 
diseases. Hence, when a physician is in attendance, such 
matters should be referred to his judgment, and no article 
of diet ought to be given except upon his advice. If no doc- 
tor is at hand to consult, the mother will give it only the 
blandest articles — such as she knows to be simple and easy 
of digestion, and those only in small quantities at a time. 
The stomach of a sick child is capable of digesting but very 
small quantities of any article, and the mother, knowing this 
fact, should see that it is not overtaxed with food. 

The discharges from the child's bowels must be speedily 
removed from the room and taken to a safe place and kept 
for the inspection of the physician. In some diseases it is 
important that he should have a knowledge of the quantity 
and character of the stools, and this can be known only by 
an actual inspection of the child's discharges. 

The mother should pay some attention to the child's urine 
during sickness, and be able to inform the physician of 
the number of times that it has been passed during his ab- 
sence, and its amount and color. If it presents any unusual 
appearance, and the child is old enough to permit of it, a 
sample should be saved, to hand to the physician for his in- 
spection. 

In some diseases of the lungs the matters expectorated 
by the child should be saved, so that the physician can ac- 



144 The Mother's Haxd-Book. 

quaint himself with their character and appearance. He 
should also he informed of the nature of the matters vomited 
by the child. 

During the absence of a physician, the sleep of the child 
should be watched, and any deviation from natural slumber 
should be reported to him. If it cries out in its sleep, or 
grinds its teeth, or shows other signs of nervousness, it is im- 
portant that the medical attendant be advised of it. 

In short, the mother should be ever on the watch for any 
new or strange symptom that may develop in the case, and 
be fully prepared to give her medical adviser an account of 
the symptoms observed during his absence. 



CHAPTER X. 



Signs and Symptoms of Ulse^se, 



EVERY mother should possess such knowledge of disease 
and its symptoms as will enable her to detect any depar- 
ture from good health in her children. She will thus be 
able to note the approach of disease and its character, and 
know when it is necessary to seek the advice of a physician. 

To assist her in obtaining such knowledge, the following 
pages have been written. By a careful study of the signs 
and symptoms of diseases as herein set forth, a mother will 
usually be able to tell not only when her child is sick, but 
also the nature of its sickness. 

Attitude of the Child. — A healthy child seldom remains 
still when awake, but if very young, will amuse itself with 
its arms and legs, keeping them in constant motion. The 
face and eyes are constantly changing in expression. As 
the child gets older it is usually playing with its toys, or else 
running about and amusing itself in various ways. It is 
capable of taking a vast amount of exercise in this manner, 
and when at last it becomes tired, it soon falls into a sleep, 
from which it awakes refreshed and ready to go through the 
same routine of amusement. 

As soon as a child becomes sick its manner undergoes an 
entire change; the eyes are dull and heavy, or occasionally 
(though rarely) extremely bright. It ceases to take any in- 
terest in play and lies still and listless, or if it moves at 
io [145] 



146 The Mother's Hand-Book. 

all, it is in a languid and difficult manner. If it is very 
young it ceases to rub its mouth with its clenched fists, as 
it usually does in health, and, its muscles being relaxed, it 
lies loosely in its nurse's arms, making no efforts to support 
its body in any fixed position. In some wasting diseases, as 
diarrhoea, the arms fall in any position by the child's side 
without any effort on its part to direct them. 

The countenance in health is expressive of serenity of mind 
and body; in disease it is so changed as to indicate to some 
extent the part of the body affected. 

If there is pain in the head the brows will be contracted, 
and this may be the first symptom of a dangerous affection 
of the brain. As the disease progresses, however, the eyes 
will become fixed and staring; the hands will be frequently 
placed to the head, which is often hot and moved from side 
to side upon the pillow. The child will grind its teeth, start 
in its sleep, and may wake alarmed and screaming. 

When the lips are drawn apart so as to show the gums, it 
indicates pain in the abdomen. This pain may be caused 
by irritation, or colic, the effect of undigested food, or by in- 
flammation of the bowels. 

Pain produced by colic is manifested by spells of loud 
crying, between which the child lies easy and has a natural 
expression, while the pain that accompanies inflammation 
of the bowels is continuous and is often expressed by moans. 
In the latter disease the expression is anxious; the child 
draws up its legs, and, in advanced cases, it picks at the bed- 
clothes. 

If the nostrils are drawn upwards and are in quick motion, 
the pain is in the chest. This sign is observed in pneumo- 
nia, bronchitis, croup and other inflammatory diseases, and 
is accompanied by quickened respirations which are mostly 
abdominal — i. c, the child's abdomen will rise and fall with 
each respiration more than the chest does. 



Signs and Symptoms of Disease. 147 

The cries of an infant should be carefully studied, for by 
this means it makes known its wants. They indicate, to 
those who understand them, not only that the child is sick, 
but also the kind of sickness from which it suffers. The 
first cry that a mother learns to know is that of hun- 
ger, and a little observation will teach her to recognize it 
readily. A hungry infant upon awakening from sleep will 
put out its tongue, move its head about as if in search of 
the breast, and, if it sees its mother, will plainly show its joy 
at the sight. If she gives it the breast it will eagerly take 
its meal; but if she is not present, or neglects to let it nurse, 
it will soon begin to cry and keep at it until its wants are 
supplied, after which it will at once become pacified. If 
the cry results from pain or sickness, although it may take 
the breast, yet it will not cease crying for any length of time, 
but in a little while it will begin again in louder tones than 
before. 

A child suffering from slight discomfort, such as is pro- 
duced by lying too long in one position, will usually make 
its suffering known by a low, continuous cry. 

The cry of pain and suffering from disease is expressed 
in various tones. 

If a child that has been cheerful and good-natured be- 
comes fretful and peevish, with its fingers continually in its 
mouth, the indications are that a tooth is making pressure 
on a tender and inflamed gum, thus giving rise to the pain 
from which it suffers. If a child cries violently or screams, 
it denotes either severe pain or passion. If it is from pain 
and the child is continually drawing up its legs toward its 
body, it denotes trouble in the bowels. If it gives short, 
piercing screams, with long intervals between them, and es- 
pecially if the head be rolled from side to side, it denotes 
either inflammation of the brain, or ear-ache. The cry from 
ear-ache, though similar in sound to that from brain disease, 



148 The Mother's Hand-Book. 

is more prolonged, lasting for quite a time, while the cry 
from the latter disease is sudden, piercing, and not continu- 
ous. The distinction between the two can readily be made 
by gently pressing on the ear-tube during a period of quiet, 
when, if there be ear-ache, the child will be thrown into a 
paroxysm of crying. If pressing upon one ear does not 
cause the child to cry, the other must be tried before con- 
cluding that the pain is not the result of ear-ache. 

In diseases of the lungs, the cry is usually labored or 
smothered; in croup or laryngitis, it is metallic or brassy; 
and in tuberculous and other wasting diseases, it is of a 
moaning or wailing character. 

If the violent crying is simply the effect of temper, the 
child will sometimes hold its breath for a long time — until it 
gets purple in the face — thus adding to the mother's distress. 
This can be overcome by plunging one or both of the child's 
hands into cold water, which will produce gasping, and 
cause it to take a full breath, when the trouble is ended. 

Voice. — In inflammation of the tonsils and the back part 
of the throat, as well as in some cases of diphtheria, the 
voice will be nasal in character. This nasal tone of voice 
is present in children with enlarged tonsils, when they are 
suffering from the effects of cold. 

In croup the voice is to a great extent lost, the child being 
unable to speak above a whisper. 

In bronchitis, pneumonia, and pleurisy, speaking is pain- 
ful, and hence the voice will be, to some extent, suppressed 
and jerky. 

The color of the shin should be examined. In eruptive dis- 
eases the neck, breast and arms, as well as the face, should 
be noticed. In jaundice the skin is of a yellow color, but 
the best test is the color of the white of the eye, which, in 
cases of jaundice, becomes yellow before much change is 
noticed in the skin itself. 



Signs and Symptoms of Disease. 149 

The sleep should be carefully watched. A healthy child 
always sleeps calmly and peacefully. Occasionally it may 
be noticed to smile in its sleep, which has given rise to the 
saying that the "angels are whispering to it." 

In sickness it may cry out suddenly with or without wak- 
ing, and may grind its teeth, or give other evidence of more 
or less pain. The mother should also note whether the sleep 
is continuous or frequently interrupted, and whether the 
skin is moist or dry during sleep. 

Cough may be a symptom of a serious disease, or it may 
be the expression of a slight indisposition unattended with 
danger. A cough without fever, or difficulty of breathing, 
usually depends upon a simple cold, attended with a slight 
irritation of the mucous lining of the throat or larynx. 
Cough, accompanied with fever and difficulty in breathing, 
may indicate the approach of pneumonia or bronchitis, or 
if it is hoarse, croup is to be feared. If, with the cough and 
fever, the child's eyes are watery, and if it is troubled with 
sneezing, measles may be suspected, and if it has been ex- 
posed to that disease the suspicion amounts almost to a cer- 
tainty. 

Long-continued coughs indicate a serious condition of the 
system. If a child with a persistent cough has been losing 
flesh for a long time, the probabilities are that it is suffering 
from some serious disease of the lungs, and this view will 
be strengthened if it be of consumptive or scrofulous pa- 
rentage. , 

Whooping-cough is known by the cough appearing in con- 
vulsive paroxysms. The intervals between the attacks may 
be long or short, according to the stage and severity of the 
disease, and after it has progressed for some time the charac- 
teristic "whoop" will be noticed. 

Convulsions may or may not be preceded by premonitory 
symptoms. Many cases occur without any warning of their 



150 The Mother's Hand-Book. 

approach, while in others, symptoms of a deranged condition 
of the nervous system are noticed long before the convul- 
sive seizure takes place. 

The symptoms that indicate a liability to convulsions are 
the constant raising of the child's hands to the head and 
crying out as if in great pain. When awake the child's 
senses seem unusually acute, and loud noises frighten it, 
producing sudden startings. The face changes color fre- 
quently and has a peculiar expression. The thumb may be 
drawn in upon the palm of the hand, or the toes forcibly 
flexed upon the foot. 

Before the occurrence of convulsions we may find the 
child's head drawn backwards, or an arm may be firmly 
fixed by the side of the body, or else a leg may be bent up- 
wards, and remain in that position. These are all danger- 
ous symptoms, and indicate disease of a most serious char- 
acter. These symptoms may continue for a few days before 
a convulsion occurs. A short time before the convulsive 
attack, the child becomes unusually quiet; it has a peculiar 
stare, the eyes being fixed in one direction. In a little 
while the convulsion begins; the body becomes stiffened; 
the head is retracted; the arms and legs are rigidly ex- 
tended; the eyes are turned upwards, and for a moment the 
child ceases to breathe. In a few seconds the face becomes 
congested; the eye-balls, with an upward stare, are twitched 
rapidly in different directions. The tongue is often bitten, 
and froth, mixed with blood, may escape from the mouth. 
The muscles of the arms and legs are thrown into spasmodic 
action, causing them to twitch and jerk with great rapidity. 

The condition of the eyes should be noticed. In health 
they are clear and bright, while in disease they often be- 
come dull, giving a heavy appearance to the countenance. 

Sometimes in disease of the brain the eyes are, for awhile, 
unusually bright, but as the disease progresses they lose 



Signs and Symptoms of Disease. 151 

their lustre, and in the last stages a film seems to form over 
them. 

When a child whose eyes have before been unaffected is 
attacked with squinting, or crossed eyes, the most serious 
results may be apprehended. The trouble may be due to 
paralysis caused by convulsions, or to irritation situated in 
the brain or in the intestinal tract. If the squint follows a 
convulsion, the result of intestinal irritation, it may disap- 
pear after the child has recovered from the convulsive at- 
tack; but more often it will be lasting, and being caused by 
a brain lesion, it is, in such cases, a forerunner of death. 

The pupils may be either too large or too small. When 
large, if they contract when a bright light is allowed to fall 
upon the eye, the probabilities are that the child is suffering 
from some nervous disturbance of a trivial character. In 
serious brain disease the pupils, if large, remain so, the 
light having no effect upon their size. As a rule, when one 
pupil is large and the other small, serious brain trouble may 
be feared; but this condition sometimes, though rarely, oc- 
curs in children who are suffering from intestinal worms. 
Inflammation of the iris, by producing adhesions between 
it and the adjacent structures, may also render the pupil 
permanently small, but in such cases it is usually irregular 
in shape. 

When both pupils are small and do not dilate when light 
is excluded from the eye, it denotes disease of the brain, or 
else that the child is suffering from an overdose of opium. 

The condition of the pupils can be easily tested by expos- 
ing the eye (the lids being held wide apart) to a bright light, 
when, in a healthy child, the pupils will contract and become 
quite small. Then, by placing a hat or other dark object 
before the eyes, the light is excluded from them, when the 
pupils will enlarge unless some disease interferes with their 
dilatation. 



152 The Mother's Hand-Book. 

Sometimes a child complains of neuralgia affecting an 
eye and a part of the forehead. Ordinarily this is the re- 
sult of a simple neuralgia, and not a dangerous symptom. 
But if with these symptoms the eye squints, or if the upper 
lid of one eye droops over the eyeball, or if the child has 
double vision — seeing two objects where only one is pres- 
ent — the probabilities are that it is suffering from tubercular 
meningitis, a disease that is nearly always fatal. 

The Tongue. — Inflammation of the mouth and of the 
stomach produces a red, hot, and dry tongue. In indiges- 
tion and irritation of the bowels from worms and other 
causes, the tongue is coated with a white fur. This white 
fur should not be confounded with the deposit of thrush, 
which occurs in patches and is not spread evenly over the 
tongue. When the tongue is coated with a yellowish fur it 
usually indicates long-standing derangement of the stomach 
and liver. A dry, brown tongue is seen in low, typhoid con- 
ditions of the system. In diphtheria and scarlet fever the 
tongue is usually heavily coated with a white fur, and in the 
latter disease the enlarged papillce project through and above 
the fur, constituting what is known as the " strawberry 
tongue." Dryness of the tongue usually occurs in advanced 
stages of disease. In addition to being dry the tongue may 
have cracks or fissures on its upper surface, an indication 
that the disease is of a grave character. Sometimes the 
tongue is coated over most of its surface with a white fur, 
except in spots of irregular shape where the coat has " slip- 
ped off," as it were, leaving the spot bare and smooth. This 
condition usually indicates irritation of the stomach or bow- 
els from worms or other causes. 

When a child begins to recover from sickness the far grad- 
ually disappears and the tongue assumes its natural color. 
This cleaning process should begin at the edge and approach 
the centre. If, after being heavily coated, the fur slips off 



Signs and Symptoms of Disease. 153 

suddenly, the tongue is usually left quite red, with a tendency 
to dryness, and in most cases the fur will again form upon 
it. Patients with such tongues are usually slow in conva- 
lescing from sickness. 

The pulse, if rightly understood, gives important informa- 
tion in diseased conditions. The mother should familiarize 
herself with the subject by studying her child's pulse in 
health and in disease. 

With the middle and index fingers of the right hand upon 
the child's wrist, over the radial artery, and a watch held in 
the left hand, the number of heart beats per minute, as 
shown by the pulsations in the artery, can be counted. 

At first it will be very difficult for the mother to count the 
precise number of beats per minute, but after a little prac- 
tice she will have no difficulty on this point. This exami- 
nation should be made several times a day, and any devia- 
tion from the first count should be noted. 

The number of pulsations per minute varies so greatly in 
young children that it is difficult to fix upon any certain 
number as representing the average. Some authors conclude 
that in the new-born child the heart beats from 130 to 140 
times per minute, while others contend that the average rate 
will not be over 102. 

The mother, by frequent examinations, can ascertain the 
number of heart-beats per minute, and thus easily detect any 
increase that may be due to disease. 

The examination of the pulse should be made while the 
child is asleep, for when awake the pulse is liable to be in- 
creased by many causes not connected with sickness. The 
mother should also notice whether the pulse is regular or 
irregular. If it beats several times at regular intervals and 
then misses a beat, she should make a note of this fact. 

In fevers and inflammatory diseases the pulse is increased 
in frequency. In bronchitis and in heart troubles it is often 



154 The Mother's Hand-Book, 

irregular or intermittent. In brain diseases it is usually 
increased in frequency, but in advanced stages it may be- 
come slow and sometimes intermittent When sleeping, the 
pulse is slower than when awake. 

The pulse should be counted when the child is awake and 
in a placid mood as well as when it is asleep. A startling 
sound, or anything else that frightens a child, will increase 
its pulse-rate. 

Sometimes the beats can be counted only with great diffi- 
culty in one wrist, but are easily felt in the other. Persons 
often say that they have no pulse in one arm, or that it is 
weak, when, in fact, it is as strong in one wrist as in the 
other; but in one the artery lies deeper than in the other, 
and, of course, it is felt with less distinctness than in the 
wrist where it is nearer the surface. 

In most diseases the pulse is greatly quickened, being in- 
creased in proportion to the severity of the complaint. 
This, however, is not always the case, for in some of the most 
serious forms of brain disease it is sometimes extremely 
slow. Also, in some cases of jaundice it is far below the 
normal standard. 

The temperature of the body is readily obtained by means 
of a thermometer, the use of which is easily learned. The 
instrument should be placed in the arm-pit or in the child's 
groin, and kept there for five minutes. It must be placed 
in close contact with the body, and no air allowed to reach it. 

The heat of the body, as shown by the thermometer, 
should be noted several times a day, and the physician must 
be informed of any variation in the patient's fever during 
his absence. 

The degree of temperature enables one to determine with 
accuracy the febrile condition of a patient; but it does not, 
in all cases, indicate the degree of danger to life that may 
be present. 



Signs and Symptoms of Disease. 155 

A long-continued and high temperature depresses and 
weakens all the organs of the body, leading in some cases to 
death from paralysis of the heart. But in some forms of 
brain disease, the temperature as well as the pulse is no cri- 
terion of the severity of the attack, or the danger that may 
surround the patient. In such cases we look to other phe- 
nomena to enlighten us as to the patient's real condition. 

The same degree of disease produces in children a higher 
temperature than in adults; hence a very high temperature 
in the former may not be attended with as much danger as 
in the latter. 

In the beginning of scarlet fever and pneumonia, the 
temperature usually becomes very high at an early period. 
In typhoid fever it gradually increases during the first 
four or five days, being about two degrees higher in the 
evening than in the morning. In inflammatory diseases 
and in continued fevers, a steady and continuous fall in the 
evening temperature for a few days, if the other symptoms 
become milder, indicates the beginning of a favorable ter- 
mination of the case. ' 

A little while before death the temperature may take either 
a sudden rise or fall of several degrees. In death from peri- 
tonitis and diseases attended with great exhaustion, the tem- 
perature often drops below the normal standard some hours 
before the fatal issue. 

The Respiration. — A respiration consists of two acts — 
first, inspiration, or filling the lungs with air ; second, ex- 
piration, or emptying the lungs of air. The latter act re- 
quires a little more time for its completion than the former. 

In a healthy person there are four heart-beats to one re- 
spiration. Thus, a healthy adult will respire eighteen times 
per minute, while his heart will beat four times as often. 
As a rule, this proportion is kept up in disease, but many 
exceptions may occur. 



15G The Mother's Haxd-Book. 

Thus, diseases of the heart, or of the respiratory organs, 
will usually interrupt the relation that one bears to the 
other in health. In all inflammatory conditions there 
will be some increase in the number of respirations, but in 
pneumonia, bronchitis and other diseases of the chest, they 
will not only be greatly increased, but will also be labored, 
the breathing being difficult and painful. 

To count the number of respirations per minute in a child 
is very difficult, except when it is asleep, and therefore, if 
possible, it should be done at that time. While sleeping, 
the child's breathing will not be affected by external in- 
fluences, and hence the respirations at that time will be a 
truer index of the condition of the lungs than when it is 
awake. The respirations can easily be noted by placing the 
hand under the clothes and upon the lower part of the 
child's chest. At each inspiration the hand will be raised,, 
and at each expiration it will be lowered. The mother can 
count the number of times the hand is raised in a minute, 
and this will give her the number of respirations. 



CHAPTER XI. 



diseases of iJi* MoutJit Wf\tnaty mtft ^ir 



SORE THROAT, OR PHARYNGITIS. 

SORE THROAT is usually caused by exposure to cold, and 
although it is seldom a dangerous affection, yet if ne- 
glected, and if the child is still further exposed to the cause 
that produced it, disease of a serious character may result. 
In that form of sore throat known as follicular pharyngitis, 
small specks having a whitish appearance may be seen on 
the tonsils, causing the mother to fear that her child has 
diphtheria. 

Sore throat (simple pharyngitis) begins with restlessness, 
irritability, fever and slight cough. If the child is nursing, 
it will likely refuse to take the breast, because of the pain 
produced by swallowing; if older, it will complain of pain 
in the throat. The fever may be slight, or of considerable 
intensity, in which case the face will be flushed and hot. The 
child is usually drowsy and cross, requiring the nurse to hold 
it in her lap while it sleeps. The breathing will be fast or 
hurried, but not difficult or oppressive, unless the windpipe 
is affected. The pulse will be quick, but regular. If there 
is much fever the thirst may be great, but owing to diffi- 
culty in swallowing, caused by the sore throat, the child 
will drink but little at a time. If there is no trouble in the 
windpipe the voice will be natural unless there is some cn- 

[157] 



158 The Mother's Haxd-Book. 

largement and inflammation of the tonsils, in which case it 
will be thick or muffled, and the child, while sleeping, will 
snore loudly. 

If the tonsils be chronically enlarged, the loud snoring 
and thick voice will be permanent ; but if the swelling be 
due to the acute attack, these symptoms will subside when 
the inflammation disappears. 

An inspection of the throat will usually enable one to tell 
whether the patient has pharyngitis, or diphtheria. If it be 
the latter, the peculiar deposit of that disease will be seen 
in the throat within a few hours after the beginning of the 
attack. The deposit of diphtheria consists of white patches, 
that adhere firmly to the parts. These patches may at first 
be rather small, but in a little while they become quite large, 
in some cases forming a c-ontinuous membrane covering 
the whole of the back part of the throat, the tonsils, and 
the roof of the mouth. In other cases they are limited to 
the tonsils and a part of the throat. 

Sometimes in simple sore throat white specks can be seen 
scattered over the tonsils and adjacent parts. These specks 
are small, and instead of consisting of a false membrane, 
as in diphtheria, they are, in fact, little white points of ul- 
ceration. This condition is known as follicular sore throat, 
and is not, like diphtheria, a very dangerous disease. The 
affection is often mistaken for diphtheria, and it is owing to 
this fact that we often meet with children that are supposed 
to be peculiarly liable to diphtheria, having had, according 
to their mother's belief, perhaps a dozen attacks. 

When a child becomes restless and feverish, with other 
symptoms indicating sore throat, the mother can with the 
handle of a teaspoon make firm pressure on the tongue to 
hold it down and expose the affected parts. The child's 
hands must be firmly held to keep them out of the way. 
Pressure upon the tongue will cause the child to " gag," 



Diseases of the Mouth, Throat, Etc. 159 

permitting a hasty A r iew of the diseased structures. It will 
require a little experience to enable one to see all the parts 
at one inspection, and if the first examination does not sat- 
isfy the mother as to the condition of the throat the opera- 
tion must be repeated. As this examination is disagreeable 
and annoying to the child, it should be completed as soon as 
possible. 

If the throat is red and inflamed, and no white spots 
can be seen, the inference is that the child has simple pha- 
ryngitis, and no further inspection need be made for several 
hours. 

If small white specks are discovered, the case is likely 
one of follicular sore throat, and but little anxiety need be 
felt; but if white patches of some size be noticed, and espe- 
cially if the tonsils and other parts be fully covered with a 
white deposit, the disease is probably diphtheria, and the 
services of a physician must be secured without delay. 

The treatment of an ordinary sore throat from exposure to 
cold is simple, and in many cases can be left to the intelli- 
gent mother. 

In ordinary sore throat a liniment composed of hartshorn, 
sweet oil, and oil of cinnamon, can be frequently used over 
the front part of the neck and under the jaws, while the 
child's bowels should be kept open with the syrup of rhu- 
barb or castor oil. If there is much fever, a mixture con- 
taining syrup of ipecac and sweet spirits of nitre may be 
given, in small doses, every two or three hours. 

If the child is old enough to gargle, it can use for that 
purpose a mixture made by dissolving a teaspoonful of tan- 
nin in a tablespoonful of alcohol, to which four tablespoon- 
fuls of water has been added. If a half teaspoonful of 
powdered chlorate of potash be added to this mixture it will 
render it more efficient. Let the child first gargle with very 
warm water to cleanse the throat and remove the mucus, so 



160 The Mother's Hand-Book. 

that the medicine will come in contact with the diseased 
surface. The gargle can be repeated every three or four 
hours, and each time after it has been used the child should 
swallow half a teaspoonful of the mixture, so as to touch 
the lower parts of the throat. 

If the child is too young to use the gargle, the mother can 
take a soft camel's-hair pencil, and, dipping it into the mix- 
ture, brush the inflamed parts with it. Two applications at 
each sitting must be made — the first to remove the mucus, 
thus permitting the second one to come well in contact with 
the diseased surface. After each application to the throat, 
a few drops of the mixture, into which the brush has not 
been placed, can be given the child to swallow. 

The diet during the treatment should be carefully regu- 
lated. Fluids and semi-solids that are nutritious and easily 
digested should be given. 

If, during the progress of the case, the voice becomes 
hoarse, or the breathing difficult, no time must be lost be- 
fore sending for a physician ; but it should be borne in mind 
that the breathing may be fast or hurried, without becoming 
difficult. When the child has a fever it will have quick or 
hurried breathing ; but if croup is present, the breathing 
will be difficult or hard, the child making great exertion to 
get its breath. 

ENLARGEMENT OF THE TONSILS. 

About the termination of the second year of infantile life, 
many children are affected with enlargement of the tonsils. 
The disease is apt to attack those who are born of scrofulous 
parents, although some have supposed that it is more preva- 
lent in children brought up on artificial food than in those 
who nurse their mothers. Be that as it may, there can be 
no doubt but that in most cases careful inquiry will dis- 
close the fact that the blood of at least one of the parents 
was tainted with scrofula. 



Diseases of the Mouth, Throat, Etc. 161 

The disease seems to develop gradually, and usually its 
existence is not suspected until the child, having taken 
cold, complains of sore throat and some difficulty in swal- 
lowing, attended with considerable fever. Upon examina- 
tion the tonsils will be found red, swollen, and inflamed, 
with a few white patches upon them. These symptoms 
clearly indicate follicular tonsilitis, a disease that has already 
been treated of. In a healthy child, perfectly free from any 
hereditary disease, the tonsils, after the disappearance of the 
inflammation, assume their natural size and form, but in 
those who are scrofulously inclined they remain large after 
the child has recovered from the acute symptoms. Other 
attacks will soon follow, for it is well known that children 
with enlarged tonsils are liable to suffer repeatedly from 
acute follicular tonsilitis, the trouble being caused in most 
instances by a common cold that in other children might 
not produce much discomfort. 

The surface of an enlarged tonsil is uneven and often 
pitted. Sometimes, especially if acute inflammation be pres- 
ent, small ulcerated white spots will be noticed. Usually, 
however, little specks of a thick, sticky secretion will be seen 
filling up the cracks and fissures in the tonsil. In chronic 
cases small lumps of lime are occasionally found lying in 
fissures that have been produced by former ulcerative ac- 
tion. 

When the tonsils are enlarged, the voice is thick and 
muffled, the hearing is sometimes impaired, and as the pos- 
terior part of the nostrils is closed by the enlarged struc- 
tures, the child is compelled to breathe through its mouth. 
The breath is offensive, owing partly to the decomposing 
secretions in the glands and partly to the offensive mucus 
that clings to the throat. 

The tonsils may be so much enlarged as to inter fore with 
both swallowing and breathing. Sometimes the patient can 



162 The Mother's Hand-Book. 

swallow only small quantities of food at a time, and that is 
done slowly and carefully. 

In many cases respiration is seriously interfered with. At 
night the child is very restless while asleep, snoring loudly 
and awaking often to change its position in bed. The 
closure of the posterior nostrils compels it to keep its mouth 
almost constantly open, and renders it liable, from external 
influences, to inflammation of the throat and air-tubes. The 
obstruction to the entrance of air into the lungs leads to 
serious changes in the chest walls. In aggravated cases the 
ribs are sunken so as to render the front of the chest flat, 
and occasionally there may be a positive depression of the 
ribs at some point. 

The treatment of enlargement of the tonsils, when acutely 
inflamed (follicular tonsilitis), is given in the article on sore 
throat. 

In the chronic form, or permanent enlargement of the 
tonsils, treatment by means of medicines administered inter- 
nally, or by local application, is unsatisfactory; but little, if 
any, good being accomplished by such measures. Excision 
with a knife, or other instrument, in cases attended with 
great difficulty to respiration, is the only treatment worthy 
of consideration. 

It is seldom that this extreme remedy need be resorted to. 
As already stated, the disease is usually noticed about the 
second year, and owing to frequent attacks of acute inflam- 
mation, due to exposure to cold, the tonsils will likely in- 
crease in size until about the ninth or tenth year, when they 
may cease growing, and as the throat continues to enlarge 
with the groAvth of the child, the breathing will likely be 
less difficult as the patient advances in age. The opera- 
tion is, therefore, seldom necessary in early childhood. But 
if the breathing becomes so difficult as to prevent the child 
from obtaining proper rest at night, thus interfering with 



Diseases of the Mouth, Throat, Etc. 163 

its general health and growth, and especially if there should 
be signs of flattening, or other deformity of the chest, re- 
sulting from an inability to properly fill the lungs with air 
on account of narrowing of the throat from the enlarged 
tonsils, the operation should be resorted to at once. The 
chronically enlarged tonsil is not very sensitive, and the 
operation of excising it is not very painful, nor is it attended 
with much danger when skillfully performed. 

THRUSH. 

Thrush is due to a fungus or deposit of parasitic origin, 
which attaches itself to the mucous membrane of the mouth. 

The disease is quite common in infants that are nursing 
the breast, as Avell as those that are artificially fed. It fre- 
quently affects children who have summer complaint, and, 
by its debilitating effect, adds greatly to the danger of that 
disease. It appears as small white specks, situated upon the 
inner surface of the lips, especially near the angles of the 
mouth, or inside of the cheeks, and upon the tongue, being 
more numerous upon the tip and edges than upon the centre. 
They are also seen upon the gums and the sides of the throat. 
The deposit looks like little bits of curd lying upon the sur- 
face of the mucous membrane, and is so firmly adherent as 
to be removed with difficulty ; and when such removal is 
made the surface below is red, and often bleeds on being 
touched with a brush or swab. At first the points of 
deposit are somewhat round and not much larger than a 
pin's head; but in a day or two they increase in size and 
become more irregular in shape. By degrees these patches 
fall off, leaving the membrane below somewhat pitted and 
redder than in health. They may reappear several times 
before the parts become healthy. In severe cases the patches 
are joined together, presenting the appearance of a false 
membrane, not unlike that seen in scarlet fever or diphthe- 



164 The Mother's Hand-Book. 

ria. As the deposit loses its vitality, and is on the eve of 
disappearing, its color changes to a yellowish or cream 
tint. 

Children affected with thrush are often the subjects of 
diarrhoea, the discharges being sour and of a greenish color. 
Such children emaciate rapidly, losing their strength and 
flesh. If the discharges from the bowels are frequent, and 
acrid in character, they soon produce redness and excoria- 
tions around the end of the bowel, which may become the 
seat of a deposit similar to that seen in the mouth. 

If the child be nursing at the breast the disease is very 
apt to attack the mother's nipple. The suction power of a 
child in nursing is so strong that it often causes inflamma- 
tion and excoriations, and if these occur the nipple will be 
almost certain to become affected with thrush. 

In the treatment of the disease, attention must be paid to 
the child's general health as well as to the local trouble. If 
the patient has diarrhoea it should be treated by a proper 
regulation of the diet. If the child is nursing the breast it 
may be necessary to wean it, at least temporarily, and place 
it upon some of the substitutes for the mother's milk. The 
rules given in reference to feeding in the article on " sum- 
mer complaint " apply with equal force to severe cases of 
thrush when complicated with diarrhoea. 

Absolute cleanliness is of the first importance in the local 
treatment of thrush. If the nurse is careful to wash the 
child's mouth and the mother's nipple with warm water, to 
which a little alcohol has been added, after each application 
of the child to the breast, the disease is not likely to occur. 
When children are fed from a bottle the greatest care must 
be taken to keep the mouth-piece clean, and to see that the 
child's mouth is properly w T ashed after each meal. 

In mild cases the diseased spots should be touched with a 
camel's-hair brush, or soft swab made of the ravelings of 



Diseases of the Mouth, Throat, Etc. 165 

old linen, dipped into the following mixture : E>issoh T e an 
even tea-spoonful of tannin in a dessertspoonful of alcohol; 
then add ten teaspoonfuls of warm water. This should he 
applied to the spots three or four times a day. 

If, in spite of this treatment, the disease does not yield, 
it may be necessary to use a much stronger wash. Twenty 
drops of muriatic acid to a tablespoonful of water forms a 
valuable application for severe cases of thrush. It should 
be used carefully with a camel's-hair brush, and if the pain 
produced by it is so severe as to cause the child to cry, the 
mixture should be weakened by the addition of more water. 

The excoriated parts about the end of the bowel and on 
the buttocks should be bathed with warm water, and then 
gently touched with the mixture of alcohol, tannin, and 
water, and when dry they can be dressed with oxide of zinc 
ointment. 

The diapers should be changed as soon as soiled, and the 
affected parts carefully bathed with warm water. 

Borax and honey, or borax and white sugar, or alum and 
honey, and similar articles, have been used as a local appli- 
cation. I do not consider them as efficacious as the reme- 
dies above mentioned. If either borax or alum be used as 
a local application in this disease, instead of mixing it with 
honey or white sugar, a much better plan is to triturate it 
with double the amount of powdered gum arabic. The 
powder thus formed can be carefully placed in contact with 
the diseased spots and left to dissolve. In this manner the 
remedy is kept in contact with the disease much longer than 
would be the case if honey or sugar were used. 

ACUTE CATARRH. 

Some children are liable to take cold from slight causes, 
and are, therefore, objects of great solicitude to their anxious 
parents. 



166 The Mother's Haxd-Book. 

Children suffering from inflammation of the mucous mem- 
brane of the nose, mouth and throat, are said to have a bad 
cold. Catarrh is the proper name for the disorder, while the 
term coryza correctly indicates the disease when it is confined 
to the nasal passages and is attended with a copious secre- 
tion of mucus. 

The symptoms of catarrh usually commence a short 
time after exposure to cold — especially damp cold — or to a 
draught of cold air. There is a sense of general chilliness and 
a feeling of cold tremors down the back. The throat and 
nose are dry and there is frontal headache. These symp- 
toms are followed by a thin, acrid discharge from the nos- 
trils, watery eyes, sore throat, and perhaps hoarseness. 
Sometimes but one nostril is affected at first, but the disease 
soon extends to the other. In a short time the discharge 
from the nose loses its thin character and becomes thicker 
and more profuse. 

Usually the patient has slight fever, the face being flushed 
and the pulse quickened. The appetite is poor, and the 
bowels often constipated. 

These symptoms usually begin to subside within a few 
days, the fever disappears, and the appetite gradually re- 
turns. The cough, although it may last for some time, be- 
comes easier and the expectoration looser. 

If a bad cold be neglected, and if the child be further ex- 
posed to the influences that produce it, serious disease of 
the lungs or the bronchial tubes may result. When the 
voice and cough are hoarse, an attack of croup is to be feared. 

Some children are so susceptible to atmospheric changes 
that they are liable to take cold from causes that in others 
would not produce such a result. To break up this tendency 
to take cold from trivial causes, the mother will be advised to 
" harden" her child by ceasing to take so much care of it 
and expose it to the cold air more frequently. To such ad- 



Diseases of the Mouth, Throat, Etc. 167 

vice the wise mother will pay no attention, but will con- 
tinue to guard with the greatest care the health and welfare 
of her offspring. 

A child should be dressed warm enough to be comfortable, 
but not so warm as to cause perspiration, for if it be ex- 
posed to the cold air while perspiring, or if it be so warmly 
clad as to induce perspiration while so exposed, it is almost 
sure to take cold. 

Mothers living in the country, on visiting their neighbors, 
often make the mistake of putting too many wraps around 
their children to protect them from the cold air. Many 
cases of sore throat and inflammatory diseases of the lungs 
have come under my notice where the trouble was brought 
on by such means. 

While it is bad practice to take a } r oung child out visiting 
during the winter and spring seasons, yet if a A r isit must be 
made the child should be clothed just warm enough to keep 
it from feeling the cold, and not warm enough to cause it to 
sweat. After it has been thus dressed, a woollen veil should 
be thrown over its face, and if no current of air is permitted 
to pass over it there need be but little fear that it will suffer 
from the exposure. 

As a child grows older it must be taught to keep its head 
covered when in the cold air; otherwise it will be out-doors 
during the coldest weather with no head covering whatever. 
A cold in the head, or, perhaps, inflammation of the brain, 
will often follow such imprudence. 

A cold in the head, if promptly and properly attended to, 
is a trifling affair; but if neglected, and if the child is al- 
lowed to still further expose itself, serious disease of the 
windpipe or lungs may result. 

The worst form of croup begins as a simple cold; but the 
changed voice and the hoarse or brassy cough, together with 
a feverish condition of the system, reveal the true nature of 
the case. 



168 The Mother's Hand-Book. 

Besides taking good care of the child, the treatment of a 
simple cold consists of a mnstard foot-bath and a restriction 
of the diet to the mildest articles, together with a proper 
dose of the simple syrup of rhubarb to move the child's 
bowels. If there is much fever a few drops of sweet 
spirits of nitre can be administered, and if the cough is 
troublesome, and especially if it or the voice is at all hoarse, 
the syrup of ipecac must be given in small doses and at fre- 
quent intervals. 

SNUFFLES. 

This is a disease of very young children, and is caused by 
exposure to cold. In cases of snuffles the nostrils of the in- 
fant are closed by crusts of dried mucus and by scabs at the 
orifice, causing great difficulty and distress in breathing. 

A child instinctively breathes through its nostrils and 
not through its mouth. Hence, if the nostrils be partially 
closed, the breathing will be difficult. In such cases the 
child, in order to fill its lungs with air, will start forward at 
intervals, throw its hands wildly about, and open its mouth 
to admit a larger stream of air into the lungs. If it would 
continue to keep its mouth open and breathe through it, the 
distress would not be so great; but this it will not do, and as 
soon as it has taken a full inspiration it will close its mouth 
and again try to get its breath through its nostrils. Even 
if but one nostril is closed the breathing will be difficult; 
but if both be impervious to air the child's life may be im- 
perilled by the disease. Although it can relieve itself by 
opening its mouth and taking a full inspiration, yet it will 
do this only when driven to it by absolute necessity. The 
insufficient amount of air taken into the lungs to purify the 
blood, may, in the end, produce a fatal effect upon the brain. 
Hence, snuffles should not in every case be looked upon as 
a trifling affair unattended with danger. 



Diseases of the Mouth, Throat, Etc. 109 

It might be supposed that, in very severe cases, forcibly 
separating the lips and keeping the mouth open would over- 
come the trouble; but such is not the fact, for even if the 
lips should be separated so as to permit the air to enter the 
mouth, the tongue may be drawn against the back part of 
the throat in such manner as to prevent the air from enter- 
ing the windpipe. 

Treatment. — The nostrils, from the very beginning of the 
disease, should be kept moist with some oily substance. A 
camel's-hair brush can be dipped into a mixture of alcohol 
and water — one part of the former to five parts of the lat- 
ter—and applied to the nostrils frequently. The wash 
should be followed each time by vaseline carefully intro- 
duced into the nostril. 

If the child's bowels become at all constipated a dose of 
castor oil or syrup of rhubarb can be given occasionally. 

COUGH. 

A cough is usually due to irritation affecting some portion 
of the respiratory tubes, or the nerves that are distributed 
to them. So great is the sensibility of the respiratory tract 
that the mere inhalation of cold dry air will, in some cases, 
produce cough. Cough may be owing to the presence of 
mucus in the air tubes, or it may be the result of conges- 
tion with undue dryness of the bronchial mucous mem- 
brane. It may also be produced by irritation situated within 
the stomach, the ear, and other organs. Elongation of the 
uvula, or " falling of the palate," often produces a most in- 
tractable cough. 

In the treatment of cough, reference must be had to the dis- 
eased condition that gives rise to it. Thus, if it is of a sym- 
pathetic character and arises from irritation of the stomach 
or other organs, the treatment should consist in the use of 
such remedies as are calculated to allay such irritation. If 



170 The Mother's Hand-BooS. 

the uvula is elongated to such an extent as to produce a 
persistent and harassing cough, it may he necessary to re- 
move a small part of its dependent portion. Elongation of 
the uvula to this extent, however, is not often met with in 
childhood. No attempt should he made to stop a cough that 
depends upon congestion and dryness of the mucous mem- 
brane of the air tubes, as by so doing the bronchial conges- 
tion would be aggravated. In such cases small doses of the 
syrup of ipecac, frequently given to keep up a slight nau- 
seating effect, will be proper. 

As the disease subsides, and the expectoration becomes 
loose and free, the ipecac can be discontinued, and a mixture 
consisting of one part of glycerine to three of the syrup of 
horse-radish can be substituted; the dose being one teaspoon- 
ful for a child two years old. 

If, at any time, after the fever and other acute symptoms 
have subsided, the cough becomes so incessant and trouble- 
some as to prevent the child from getting needed rest, a few 
drops of Godfrey's Cordial can be added to any ordinary 
cough mixture that does not contain opium, and given often 
enough to moderate the violence of the cough. But it should 
be remembered that when there is a secretion of mucus in 
the air tubes, a cough is nature's means of ridding the lungs 
of such secretion, and hence in such cases cough medicines 
should be given with great caution. 

The cough that usually accompanies a slight cold seldom 
requires any specific treatment. The child's bowels must 
be kept open, and its diet should be carefully attended to. 
If there is much fever, and if the cough is troublesome 
enough to prevent sleep, a few drops each of sweet spirits 
of nitre and syrup of ipecac, to which a half drop of God- 
frey's Cordial for each month of the child's age has been 
added, can be given every three or four hours until relief 
has been obtained. 



Diseases of the Mouth, Throat, Etc. 171 

If the child is quite feverish, with a hoarse voice and a 
brassy cough, there is danger of membranous croup. In 
such cases a physician must be sent for without delay, and 
until his arrival the mother can administer small doses of the 
syrup of ipecac every two hours to induce slight nausea. 
It should be borne in mind that hoarseness in a child must 
never be neglected. It indicates that there is some disease 
in the windpipe, and no one can tell when it may develop 
into an inflammation that will imperil the life of the child. 

The child should be protected against further exposure to 
cold, and, when asleep or awake, should be kept in a room 
comfortably warm ; where the temperature is from 65 to 68 
degrees, and where there are no draughts of air. 

The front of the child's neck, over the windpipe, can be 
bathed with a liniment made of one part of spirits of ammo- 
nia and two of sweet oil, to which have been added a few 
drops of oil of cinnamon. If necessary, the bowels should 
be kept open with the syrup of rhubarb or castor oil. 



CHAPTER XII. 



<®tl|fc? 33is£a$£Si txt tfte ^ir^|J&$Si«se$* 



CROUP. 



THERE are two forms of this disease: first, false croup, 
or, as it is more properly called, spasmodic laryngitis, and 
second, true or membranous croup. 

The first, which is most common, is comparatively free 
from danger, while the latter is one of the most dangerous 
diseases that afflict children. 

False croup is usually sudden in its invasion. An other- 
wise healthy child, after having been exposed to the influ- 
ence of cold, or to a draught of air, awakes suddenly in the 
night struggling for breath. It throws itself about in the 
bed and seems to be in the greatest danger of suffocating. 
If it tries to cry or speak, its voice will be suppressed or re- 
duced to almost a whisper. When it attempts to cough, the 
sound is hoarse or brassy, constituting the croupy cough, 
which when once heard is always remembered, and is a 
source of the greatest alarm to mothers. 

Since the disease is mostly of a spasmodic nature, the 
child will not have a high grade of fever, the skin being 
often bathed in perspiration. 

In many cases the services of a physician cannot be se- 
cured promptly; hence the mother must undertake to relieve 
her child; and if she is provided with the proper means she 
can usually succeed in giving relief to the little sufferer in a 
short time. 

[172] 



Diseases of the Air-Passages. 173 

Treatment. — On finding that her child is suffering from an 
attack of spasmodic croup, the mother should at once give 
it a teaspoonful of the syrup of ipecac for the purpose of 
vomiting it, and if that object is not accomplished in ten 
minutes, the dose should be repeated. If necessary two or 
three doses, ten minutes apart, can be safely given, for in 
moderate quantities this medicine is harmless. 

As soon as the ipecac has been administered, water must 
be heated to give the child a warm bath. After the child 
has vomited it will breathe much easier until the air tubes 
are again obstructed, when the close of ipecac should be 
repeated to rid the lungs of the mucus. 

After the child has had its warm bath, and has been well 
dried and placed in bed with a blanket or flannel around it, 
the syrup of ipecac should be continued in small doses every 
hour during the remainder of the, night, the object being not 
to vomit it, but to keep it slightly nauseated. If at any 
time the breathing should again become very difficult, enough 
of the ipecac should be given to produce vomiting as before. 
By such means the child will soon be restored to health, unless 
it is again exposed to the influence of cold or draughts 
of air. During the day after the attack, it will usually seem 
bright and cheerful, but when the following night approaches, 
its voice will be changed, and it will likely be subject to 
other -attacks of hard breathing and croupy cough. If it 
has been properly cared for, it will, in the course of two or 
three days, be restored to its usual health. 

Although the disease is mostly of a spasmodic nature and 
easily relieved by emetics and the warm bath, yet there are 
other changes in the windpipe, the membrane lining the 
larynx being reddened or injected. There is no real inflam- 
mation of the part; but as the membrane is already con- 
gested and swollen, there is danger that further exposure to 
the influence of cold may produce inflammation of a dan- 



174 The Mother's Hand-Book. 

gerous character. To avoid this the child must be kept in 
a room that is sufficiently warm, but not overheated; it 
should also be provided with proper clothing to protect it 
from any change in the atmosphere. 

Children who are subject to attacks of croup should wear 
flannel next to the body. The clothing should be sufficient 
to keep them comfortably warm without causing them to 
perspire freely. Nothing is more certain to cause a child to 
take cold than keeping it so warmly dressed as to produce 
free perspiration during cold weather. 

True or membranous croup is a much more fatal disease 
than the above; but, fortunately, it is of infrequent occur- 
rence, and, unlike false croup, it is rarely developed sud- 
denly. In true croup the child usually seems to suffer from 
a cold in the head with slight fever for a few days before any 
alarming symptoms show themselves. It is restless, its face 
is slightly flushed, and its pulse quicker than in health. To 
these symptoms are added thirst and loss of appetite. It 
may also have running at the nose and watery eyes, but 
nothing positively indicating the presence of croup is 
observed until the voice becomes changed. The voice in 
the beginning of true croup gradually becomes muffled 
or suppressed, and further along in the disease it is entirely 
lost, the child being able to express its wants in whispers only. 
About this time the peculiar croupy cough is heard, being 
probably the first symptom that alarms the mother. Soon 
the breathing, which before had been hurried, becomes ex- 
tremely difficult. The child throws its head back, dilates its 
nostrils, and uses every muscle that belongs to the respira- 
tory system in its efforts to fill the lungs with air. 

A careful inspection of the throat shows that in many 
cases the posterior parts of the palate and the tonsils are 
flecked with patches of white exudation. The disease is an 
inflammation of the windpipe, attended with an exudation 



Diseases of the Air-Passages. 175 

of a false membrane, which adheres closely to the parts, 
and gradually, if not removed, fills up the larynx until air 
can no longer pass through it, causing speedy death. 

Hoarseness of the voice often precedes the difficult breath- 
ing for several days, and this has given rise to the axiom 
that hoarseness in a child is always a cause for alarm. Cer- 
tain it is that a child with a hoarse voice should always re- 
ceive careful attention, and be kept from exposure to cold 
or draughts of cold air. Such a child should be kept in a 
comfortable room, of even temperature, until its hoarseness 
has disappeared. It would also be well to apply warm lini- 
ments over its windpipe, and keep it slightly nauseated, by 
giving small doses of syrup of ipecac. 

Sometimes the false membrane exists in the throat and 
upper part of the windpipe only, and by closing the tube at 
that point produces death. In other cases it is formed not 
only along the whole length of the windpipe, but also in the 
bronchial tubes*. When the obstruction is confined to the 
upper portion of the windpipe, the operation of tracheot- 
omy, made by opening the tube below the point of obstruc- 
tion, may save the child's life ; but if the disease extends 
into the lungs, involving the bronchial tubes, no good can 
be accomplished by the operation. 

This form of croup being one of the most fatal diseases 
with which children are affected, medical assistance should 
be summoned without delay ; but if no physician can be 
had in the beginning of a case, it is important that the 
mother should know how to proceed in his absence. 

As before stated, if a child shows signs of cold in the head, 
with feverishness and a hoarse voice, the mother should at 
once realize the fact that it may become dangerously sick 
unless proper means arc used to relieve it. 

Treatment. — The first thing to be done is to place it in a 
warm, well-ventilated room. True croup usually attacks ehil- 



176 The Mother's Hand-Book. 

dren in cold weather; hence a child with the initial symptoms, 
after being placed in a suitable room, should not be allowed 
to leave it. Only the blandest food ought to be allowed, and 
the bowels should be kept open with castor oil, or rhubarb. 
The front part of the neck may be bathed with a warm lini- 
ment, which should be rubbed in with the hand, after which 
a piece of thin flannel can be pinned around the neck. In- 
ternally, the syrup of ipecac should be given in small doses 
every two hours when the child is awake, the object being 
not to vomit it, but merely to produce slight nausea. 

If, in spite of these measures, the symptoms begin to 
grow worse, and no physician can be had, the mother should 
place her child in a warm bed, and apply a compress, con- 
sisting of several thicknesses of flannel, dipped in water as 
hot as can possibly be borne, to the throat and upper part 
of the chest. This compress must be changed often, as the 
heat and moisture must be kept up for a long time without 
intermission. The object of treatment now. is to loosen the 
false membrane, and cause its expulsion if possible, while 
the strength of the child should also be cared for. 

At any time after the breathing has become difficult, if 
there are signs of loosening of the membrane — which is in- 
dicated by mucous rattles in breathing and a loose cough — 
an emetic should be given. For this purpose nothing is 
better than powdered alum, in teaspoonful doses, mixed with 
honey or molasses. This acts quickly and without much 
nausea, and does not depress the patient's strength to any 
great degree. If the first dose does not produce vomiting, 
another may be given in ten minutes. 

Very often emetics seem to Irave but little effect in these 
cases, and it becomes almost impossible to vomit the patient 
with any drug. 

If the child should be so fortunate as to expel the 
false membrane by vomiting (a result not often obtained) 



Diseases of the Air-Passages. 177 

the greatest care must be taken in the after manage- 
ment of the case, for the reason that there is danger of an- 
other membrane forming. The hot applications to the throat 
and chest and small doses of the syrup of ipecac should be 
continued. The air of the room should be quite warm and 
kept at an even temperature. 

Cold air should be excluded from the patient's room by 
keeping all outside doors closed, but when this is impossible 
the child can be protected by hanging a bedquilt by the side 
of the bed. 

But few cases of true croup recover; still the mother can 
do no better than follow the foregoing directions. When the 
ordinary remedies have been faithfully tried without bene- 
fit, and the case seems hopeless, the question of trying the 
operation of tracheotomy may be considered. This is a mat- 
ter that should be left entirely with the surgeon, who will 
recommend it if he believes that the operation offers any 
chance of saving life; if he thinks otherwise he will advise 
against it. 

BRONCHITIS, OR CATARRHAL FEVER. 

This is one of the most common diseases to which children 
are subject. It is most frequent during the spring and win- 
ter months, being especially prevalent during those winters 
noted for frequent rainfalls and melting snows. 

This disease was known to the old authors as catarrhal 
fever, and in some localities it is still called by that name. 

Bronchitis usually begins as a common cold affecting the 
chest; but by degrees the symptoms, instead of subsiding, 
become more aggravated ; the fever is more marked ; the 
cough, which is frequent, is tight and accompanied with 
pain, causing the child to cry after each coughing spell. 
The respiration becomes' wheezy and irregular. The fever 
is higher and the cough more troublesome towards evening 

12 



178 The Mother's Hand-Book. 

and during the early part of the night. On awaking, the 
breathing is much oppressed, owing to the mucous secretion 
filling the larger air tubes. A fit of coughing, ending in 
vomiting, will usually clear the air tubes, when the child 
will breathe with comparative ease until the accumulation 
of mucus again obstructs the air passages. As the disease 
progresses the skin becomes moist, often being covered with 
profuse perspiration. If the ear be applied to the chest, a 
rattling sound will be heard, caused by air passing through 
the mucus contained in the bronchial tubes. As long as the 
disease is confined to the larger air tubes it is not very fatal, 
and most cases recover without difficulty; but if the inflam- 
mation extends to the smaller tubes — thus causing what is 
known as capillary bronchitis — the life of the child is placed 
in the most imminent danger. 

Capillary bronchitis may develop suddenly, but in most 
cases it occurs during the progress of ordinary bronchitis, 
or else follows an attack of one of the eruptive fevers, as 
measles. Soon after the attack begins, the breathing be- 
comes difficult and hurried; the cough frequent, short and 
hacking; the face anxious, and the eyes heavy. The child 
is very restless and changes its position frequently as though 
it could not long remain in one place. Though usually 
thirsty, it refuses, on account of difficult breathing, to swal- 
low much fluid, and contents itself with merely wetting its 
lips. Vomiting is not often present, and, indeed, in this dis- 
ease, as in real croup, it is often hard to produce it even 
with full doses of emetics. 

As the disease progresses the child becomes more and 
more restless, throwing itself wildly about the bed, and 
there is an increase of the hurried breathing, until the acme 
of the disease is reached. 

Before death takes place the breathing becomes seemingly 
easier and less frequent, though irregular. The face assumes 



Diseases of the Air-Passages. 170 

a livid appearance; the cough is smothered and not so 
persistent; the pulse is frequent and feeble; the child is 
drowsy, and arouses itself only when compelled to cough or 
struggle for breath. In this condition death soon puts an 
end to its suffering. 

In some cases during the progress of an attack of bron- 
chitis, the substance of the lung becomes involved, thus 
greatly endangering the child's life, and adding pneumonia 
to the existing trouble, constituting what is known as bron- 
cho-pneumonia. When pneumonia occurs during the pro- 
gress of bronchitis, all the symptoms increase in severity. 
The patient's general distress is more marked; the breath- 
ing is very difficult and painful; the face is livid, caused 
by the air failing to reach the air-cells; the respiration is 
irregular and hurried. This disease is very dangerous, and 
no one but a skilled physician should undertake its manage- 
ment. 

The treatment of bronchitis and pneumonia in their va- 
rious forms differs but little, and is conducted on the same 
general principles. 

The mother of a child suffering from bronchitis should at 
once see that the patient is not further exposed to the influ- 
ence of cold, but is kept in a moderately warm room. No 
medicine ought to be given to moderate or stop the cough; 
but small doses of the syrup of ipecac can be administered 
every hour or two, the object being to produce slight nausea 
without vomiting. The chest should be well rubbed with a 
liniment made of one part of spirits of hartshorn and two 
parts of sweet oil, to which a few drops of the oil of cinna- 
mon have been added. This can be warmed and applied 
often enough to keep up a very slight redness of the skin. 

If the attack is sudden, or at all severe, a mustard plas- 
ter, made by mixing mustard and flour with molasses, can 
be placed over the whole front of the chest and kept on as 



180 The Mother's Hand-Book. 

long as it does not give pain. If these measures do not give 
relief, and the breathing continues difficult and painful, it 
will be necessary to apply flannel cloths, wrung out of hot 
water, to the front and sides of the chest; or, what is better, 
to envelop the whole of the chest in a linseed or wheat-bran 
jacket, as described in the article on pneumonia. The ipe- 
cac should be continued, and if the breathing becomes very 
difficult from accumulation of mucus in the air-tubes, the 
medicine should occasionally be given in doses sufficiently 
large to produce vomiting. Attention should be paid to the 
condition of the bowels, and, while active purging must be 
avoided, a gentle movement should be secured once or twice 
a day. This can be done by the administration of proper 
doses of castor oil or syrup of rhubarb. 

For a considerable time after the acute symptoms have sub- 
sided, the child may continue to be troubled with coughing 
and wheezing. In such cases slight causes will produce a re- 
currence of the bronchitis; hence, the utmost care must be 
taken to prevent the child from taking cold. If a return of 
the disease is threatened, small doses of ipecac must be given 
three times a day and once or twice during the night; and if 
there is any appearance of a return of the fever, the ipecac 
should be given in doses sufficient to produce slight nausea. 

The directions given in regard to diet in the article on 
pneumonia apply with equal force to cases of bronchitis, 
and need not be repeated here. 

PNEUMONIA, OR LUNG FEVER. 

This disease is divided into three stages. In the first stage 
the substance of the lung is congested with blood, but the 
air-cells are to a great extent free . 

In the second stage the lung becomes solidified from in- 
flammation of the tissues and the filling up of the air-cells 
by matter that has exuded from the blood-vessels. 



Diseases of the Air-Passages. 181 

In the third stage the lung tissue becomes disorganized, 
breaking down into matter and proving fatal; or the inflam- 
mation subsides, the effused matters are absorbed or expec- 
torated, and the patient recovers. 

In children, pneumonia usually appears during the course 
of bronchitis, or it may follow an attack of one of the erup- 
tive diseases, as measles. Occasionally it occurs in children 
without having been preceded by the symptoms of bron- 
chitis. In such cases it usually begins with slight feverish- 
ness in the evening, together with fretfulness and headache. 
During the night the sleep is unsound, the child talking in 
its sleep and often waking in alarm. Soon after the appear- 
ance of the fever, a short, hacking cough ensues, which at 
first may not be distressing, but soon becomes more frequent 
and painful. The tongue is red, sometimes dry, and coated 
in the middle with a white fur. The child soon ceases to 
breathe through the nose, and is forced to take its breath 
through the mouth. If put to the breast it will be unable 
to suck as usual, but will take the milk by starts — sucking 
with greediness for a moment and then with a cry, letting 
the nipple drop out of its mouth. 

In children four or five years old, pneumonia may come 
on suddenly. A child of this age, that was apparently well 
at bed-time, wakes in the night in great alarm and distress. 
It has a flushed face, burning skin, short, dry cough, and com- 
plains of pain in the chest. Vomiting may, or may not, be 
present. If these symptoms occur in a child that has lately 
been exposed to cold while the body was warm and perspir- 
ing, they indicate the existence of pneumonia. 

As the disease progresses to the second stage, the child 
becomes drowsy and lies quietly in bed, crying if disturbed. 
The breathing is more rapid, and the sides of the nose are 
distended, or move outwards each time the child gets its 
breath. Owing to the difficult breathing the muscles of the 



182 The Mother's Hand-Book. 

abdomen are called into play to aid in the act of respiration. 
The cough is more frequent and painful. The body remains 
hot, while the feet and hands may be cool. If the lung tis- 
sue be greatly affected, the lips and skin around the mouth 
will be livid, while the face is pale. 

Pneumonia involving the greater part of the lungs, or 
commencing during a severe attack of bronchitis, or follow- 
ing an attack of measles or other disease that has greatly 
debilitated the patient, may end in death during the second 
stage of the disease. But if the child is reasonably strong 
at the time of the attack, and if the amount of lung tissue 
involved is not excessive, and if the disease has not been 
arrested by treatment, it will pass into the third stage. 

In this stage the respiration becomes more labored and 
quite irregular. The child takes a few short and hurried 
inspirations, which are followed by others that are deeper 
and longer. The cough is less frequent and looser, and 
is caused by the presence of mucous secretions in the 
larger air-tubes. The child, if it tries to speak out at all, 
does so in a hoarse whisper, and evidently with pain. The 
face looks sunken, the extremities are cold, and a clammy 
sweat breaks out on the forehead. The pulse is so frequent 
and small as to be difficult to count. The difficulty of breath- 
ing increases, the face and nails become more livid, and the 
child's drowsiness increases until death takes place. 

Occasionally convulsions occur before death, succeeded by 
a sleep from which the child cannot be aroused. Pneumo- 
nia attended with convulsions at this stage is always fatal. 

But pneumonia in childhood does not always follow the 
above course. Recovery may take place during or at the 
end of either the first or second stage ; and even in the 
third stage severe cases frequently recover — convalescence 
being protracted — the child requiring a long time to regain 
its strength. It may happen, however, that the patient, 



Diseases of the Air-Passages. 183 

after passing into the third stage, with all the symptoms of 
impending death, shows signs of improvement calculated to 
deceive the mother. Its appearance may be brighter, and 
it may even express a desire for food. The cough, which 
had nearly ceased, returns, and is loose in character. The 
breathing, though quick and short, is not so labored. The 
skin is hot and dry. The tongue is red and dry, and, in 
some cases, whitish ulcers appear on its edges. Diarrhoea 
is usually present, and the child wastes away and dies in a 
week or two, completely emaciated. 

Treatment. — This disease being attended by a high degree 
of inflammation, and especially dangerous to life in early 
childhood, no mother should take upon herself the respon- 
sibility of treating a case, but should secure the services of 
a physician as soon as possible. While medical aid is being 
obtained, the mother can render valuable assistance by pro- 
ceeding according to the following directions: 

Moist heat gives great relief in the first stages of pneumo- 
nia. Flannel cloths, wrung out of hot water, and applied 
over the whole of the front and sides of the chest, will be 
beneficial. The cloths should be folded two or three times, 
so as to hold considerable heat and moisture, and should be 
applied as hot as can be borne by the child, a piece of dry 
flannel being laid over the wet cloth. These applications 
should be renewed every fifteen or twenty minutes to get the 
full benefit of the heat. While applying moist heat to the 
chest a blanket should be placed under the child, and if the 
weather be cold, another blanket should be spread over it. 
The greatest care must be observed to prevent the child 
from taking cold during the application of wet cloths and 
poultices. No current of air should be permitted to pass 
over or near the patient. During the winter season the air 
of the patient's room must be of a moderate temperature — 
neither too hot nor too cold — and no door should be opened 



184 The Mother's Hand-Book. 

that permits the outside air to rush into it. Ventilation should 
be secured by allowing air to pass from other rooms into the 
sick-chamber. 

In severe cases, when the proper material is at hand, it 
will be best to use the jacket poultice. The jacket must be 
made of flannel, and should go around the whole of the chest 
and be fastened in front. A piece may be cut out where the 
arm-pits rest, so as to let the jacket come well up towards the 
neck in front. Strips of muslin can be tacked behind and 
passed over each shoulder, and fastened in front to keep the 
jacket in place. The poultice is best made of linseed meal, 
spread nearly half an inch thick, and applied nioist and as 
hot as the child can bear. This can be changed occasion- 
ally, so as to keep up a continuous supply of heat to the 
skin. 

No medicine should be given by the mother to stop or 
moderate the cough ; but small doses of the syrup of ipecac, 
frequently repeated, will be useful from the very beginning. 

If the bowels are at all constipated and the fever is high, 
a dose of castor oil or syrup of rhubarb may be given with 
good effect. A few drops of the sweet spirits of nitre in a 
teaspoonful of water may be administered every two hours 
when the child is awake, to moderate the severity of the 
fever and to act upon the kidneys. 

Food, during the early stages of pneumonia, should be 
given sparingly. If the child is at the breast, it will be 
well to offer it a spoonful of cold water occasionally to quench 
its thirst, so that it will not crave so much milk. If the 
breathing is so hurried as to greatly interfere with sucking, 
causing the child to fret and cry each time it nurses, the 
mother should draw her milk and give it to the infant in a 
teaspoon. As the disease progresses and the child becomes 
emaciated, efforts should be made to keep up its strength 
by feeding it more liberally. Beef tea and veal broth, or, 



Diseases of tpie Air-Passages. 185 

if diarrhoea be present, rice, arrow-root, tapioca/ or cream 
crackers grated into boiling water, to which a little hot fresh 
milk has been added, will answer the purpose. Condensed 
milk, or some of the patent foods for infants, prepared accord- 
ing to the formulas that accompanies each package, will often 
agree with the child and afford it substantial nourishment. 

The advice here given will enable the mother to give some 
relief to her child without risk of doing harm, and aid her in 
assisting the physician in his efforts to restore it to health. 

PLEURISY. 

This disease consists of an inflammation of the pleura, 
the serous membrane that lines the inside of the chest and 
is reflected over the outside of the lungs. 

The arrangement of the pleura is such that it presents two 
surfaces lying in apposition with each other. 

In health these surfaces are smooth and moist, gliding 
past each other without friction or pain. When inflamed 
the surfaces of the pleura become injected with blood and 
roughened, causing pain during respiration. 

As the disease progresses, false membranes, varying in size 
and thickness, are formed. In some cases these membranes 
become organized, causing adhesions between the two surfaces 
of the pleura. In other cases, in addition to the formation of 
a false membrane, the inflammation is followed by an exuda- 
tion of a fluid which may be either of a serous (watery) 
or purulent nature. In serous effusion the fluid is straw- 
colored, and may exist in large quantities, filling up the 
cavity of the chest, and compressing the lung into a solid 
mass. In the purulent form of pleural effusion, the fluid is 
thick (" matter" or "pus"), and of a yellowish or greenish 
yellow color. 

The term empyema is applied to the collection of pus in 
the chest cavity. In nearly all cases the effusion is at first 



186 The Mother's Hand-Book. 

of a serous or watery nature; but after remaining in the 
cavity of the chest for a week or two, in unhealthy persons, 
it becomes purulent. As before stated, the lung may be so 
greatly compressed as to be rendered useless for breathing 
purposes. In such cases respiration is maintained solely by 
the sound lung. If the effusion be in the left side of the 
chest, and excessive in quantity, the result will not only be 
compression of the left lung, but the heart will be displaced, 
being pushed over to the right side. 

If the effusion be serous or watery, and not of long stand- 
ing, absorption may take place; the patient being restored 
to health without deformity or other permanent results of 
the disease. 

Chronic pleurisy is, in most cases, an outcome of the acute 
disease. It is especially prone to occur in those persons who 
are predisposed to consumption. In chronic pleurisy the 
fever is of low grade, and resembles the hectic fever of con- 
sumption. The patient is weak and emaciated, and his 
breathing is greatly interfered with. Although he may be 
able to walk about his room, and even out-doors, yet he is 
incapable of taking much exercise, as the least exertion is 
followed by marked fatigue and breathlessness. Chronic 
pleurisy may last from a few months to as many years, re- 
covery without operative interference being rare. 

If the effusion in the chest becomes purulent, or if it is 
serous, and in sufficient quantity to seriously interfere with 
breathing, it should be evacuated by tapping. 

If surgical interference is not attempted, and the patient 
lives long enough, the fluid often makes its way out of the 
chest by ulcerating through the walls, or by opening into a 
bronchial tube, or by burrowing through the diaphragm and 
emptying into the stomach or bowels. 

The evacuation of a large amount of fluid that has been 
long contained in the cavity of the chest is usually followed 



Diseases of the Air-Passages. 187 

by a flattening or sinking in of the chest wall on the affected 
side. 

Pleurisy is often caused by exposure to cold, especially 
when the body is in a perspiring condition. It may also be 
associated with pneumonia, bronchitis and consumption. 
In Bright's disease of the kidneys, pleurisy may become a 
serious complication. 

The symptoms of pleurisy vary with the stage and severity 
of the disease. In mild cases they may be limited almost 
entirely to the peculiar pain that accompanies the first stage 
of the disease. This pain is sharp, cutting, and is greatly 
increased by breathing, coughing, and by abrupt movements 
of the body. It is usually felt a little below and behind the 
nipple, and is often limited to a small space. The pain va- 
ries in its duration, sometimes ceasing in two or three days, 
while in other cases it is felt at intervals throughout the 
whole disease. 

Except in very mild cases, pleurisy usually begins with 
a chill, followed by fever and difficult breathing, which may 
last two or three days. 

Pleurisy followed by effusion is a more serious disease than 
dry pleurisy. Usually it begins with a chill, which is fol- 
lowed by considerable fever and severe pain in the side of 
the chest, the pain being greatly increased by breathing or 
coughing. The fever increases in severity as evening ap- 
proaches and continues for a week or so, when effusion into 
the chest begins. Occasionally the pain in the side and ef- 
fusion occur before any chill or fever is.jioticed. 

When the effusion becomes purulent, or when the patient 
is disposed to consumption, the daily occurrence of chills 
may be looked for. These chills come on at irregular inter- 
vals and are followed by an increase of fever. 

Cough is usually present in pleurisy from the beginning. 
It is suppressed or cut short by the patient on account of 



188 The Mother's Hand-Book. 

the pain in the side being greatly increased by any attempt 
at coughing. 

Difficult breathing is a distressing symptom in pleurisy. 
It is caused both by the severe pain rendering respiration 
difficult and by pressure of the effusion upon the lung, mak- 
ing it impossible to fill it with air. 

Before effusion takes place, the patient lies on the sound 
side, so as to take off as much pressure as possible from the 
affected lung. After the effusion has compressed the dis- 
eased lung, rendering it to a great degree impervious to air, 
the patient is compelled to lie on the affected side in order 
to give free play to the sound lung. In the worst cases rest 
can be had in an erect or semi-erect position only. The ex- 
pectoration in pleurisy, unless bronchitis co-exists (which is 
not common) is scant, and consists of a frothy mucus. 

Pleurodynia is sometimes mistaken for pleurisy. It is of 
rheumatic or neuralgic origin, and is unaccompanied by 
fever or other evidence of inflammation. The pain is con- 
fined to a particular spot, which is excessively tender when 
pressed upon. The affection is usually of a trifling charac- 
ter, and most cases yield readily to hot applications, with 
absolute rest of the body. 

Severe and repeated attacks of pleurisy have a marked 
tendency to the production of consumption in those who 
are prone to that disease, and in fatal cases of chronic pleu- 
risy the symptoms are nearly identical with those observed 
in the last stages of phthisis. 

Pleurisy may be mistaken for pneumonia; but in the lat- 
ter disease the initial chill is usually much severer than in 
the former, and is followed hy a higher grade of fever. The 
pain in pleurisy is sharp, cutting, and limited to a small 
area, while in pneumonia it is of a dull, heavy character, 
and is usually diffused throughout a large portion of the 
lung. 



Diseases of the Air-Passages. 189 

The expectoration in pleurisy consists of small quantities 
of white, frothy mucus, while in pneumonia, after the dis- 
ease has existed a short time, it is somewhat profuse, and 
of a " brick-dust" color, owing to the admixture of blood 
with the mucus. 

Treatment.- — The treatment of the mild form of pleurisy 
is quite simple. The patient should remain quietly in bed, 
and if the bowels are at all constipated a mild purgative, 
such as the syrup of rhubarb, should be administered with- 
out delay. If fever is present, small doses of sweet spirits 
of nitre, plentifully diluted with water, can be given with 
benefit. If the pain is very severe, and is not relieved by 
hot applications to the chest, a moderate dose of Dover's 
powder, to be repeated, if necessary, in four or five hours, 
can be administered. 

In the beginning of the attack recourse should be had to 
flannel cloths wrung out of hot water and applied to the 
painful spot. If these applications fail to relieve the pain, 
after a few hours' trial, they can be discontinued, and a large 
mustard plaster, made as heretofore directed, may be used 
in their place. The mustard should be kept on the chest as 
long as it can be borne without blistering. 

The results of severe attacks of pleurisy are often quite 
serious, and hence such cases should be treated only by a 
skillful physician. 

In addition to the above-described treatment, which may 
be followed in all cases of pleurisy in the beginning of the 
attack, more powerful remedies will often be required when 
the disease does not yield readily. Thus, if the attack be 
severe, and if the patient be plethoric or full-blooded, leeches 
to the affected side will be beneficial. After leeching, the 
side of the chest should bo enveloped in a warm, moist poul- 
tice made of linseed meal or bran. Calomel, in small doses, 
may be required, while Dover's powder in moderate quanti- 



190 The Mother's Hand-Book. 

ties should be continued for the purpose of relieving pain 
and procuring rest and sleep. 

If the effusion is purulent, or if it consists of serum in 
sufficient quantity to seriously interfere with breathing, re- 
course must be had to tapping the chest and withdrawal of 
the fluid. This operation is attended with some danger, and 
should be done by one skilled in its performance. 



CHAPTER XIII. 



IHseases. of the Stomixcft anft ISotttels. 



VOMITING; 



AMONG the disorders that afflict young children, vomiting 
is one of the most frequent. Depending, as it usually 
does, upon injudicious nursing or feeding, either in the 
quantity or quality of the nourishment, it ceases in most 
cases as soon as the cause that produced it has been re- 
moved. 

Treatment. — If a child that, has been over-fed, or has been 
given indigestible food, is affected with vomiting that does 
not cease after careful attention has been paid to its feeding, 
but, on the contrary, becomes persistent, it may be neces- 
sary to resort to other measures than the mere regulation of 
its diet. 

If food is thrown up soon after being swallowed, it will be 
unchanged in character; but if it has remained for some 
time in the stomach it will be quite sour when ejected. If 
the vomiting of sour foo'd continues for any length of time, 
it will be well to give occasionally a teaspoonful of weak 
soda water (made by dissolving a teaspoonful of baking soda 
in a glass of water) to neutralize the acid condition of the 
stomach. If, after all the food has been thrown up, the 
child continues to vomit a dark or yellowish bitter substance, 
known as bile, it will be best to let it have a draught of warm 
water to assist the stomach in getting rid of such matter and. 

[191] 



192 The Mother's Hand-Book. 

to lessen the straining that accompanies the effort. If the 
vomiting continues, measures must be taken to check it and 
allay the irritation of the stomach upon which it depends. 
For this purpose very small pieces of ice may be given to 
the child occasionally, and a weak mustard plaster, made by 
mixing one part of mustard and three or four parts of flour 
with a sufficient quantity of molasses, should be applied 
over the front of the chest and the abdomen. A small mus- 
tard plaster will do little or no good, while a large one, pro- 
perly made, will accomplish the desired result, and will give 
but little pain to the child. 

"With the exception of an occasional teaspoonful of ice 
water to allay thirst, and the cold soda water (herein re- 
commended in cases of sour vomiting only), no drink or 
food of any kind should be given until the vomiting has 
ceased. 

The foregoing remarks are intended to apply to cases of 
vomiting unattended with other symptoms of disease. 

If the vomiting continues in spite of the above treat- 
ment, and if it is accompanied with other symptoms of 
disease, as feverishness, emaciation, and general indisposi- 
tion to exercise — in short, if the child seems to be sick other- 
wise than at the stomach — the services of a physician must 
be secured, as there may be danger of impending or actual 
disease of a serious nature. Persistent vomiting may be the 
first noticeable symptom of tubercular inflammation of the 
brain. 

CONSTIPATION. 

Constipation is sometimes very annoying in young chil- 
dren. While a healthy child may have but one operation a 
day, yet in most cases the bowels should be moved two or 
three times in that period; and if they become obstinately 
constipated, as shown by few operations and the hard char- 



Diseases of the Stomach and Bowels. 193 

acter of the stool, the trouble must be corrected by mild 
measures. 

Although a change from the mother's milk to artificial 
feeding is usually followed by diarrhoea to some extent, yet 
occasionally the opposite effect is noticed. This is espe- 
cially apt to be the case in partial weaning — that is, when 
the mother does not give sufficient milk for her child and 
is forced to combine artificial feeding with nursing. 

Sometimes the trouble can be overcome by a judicious 
management of the diet. If the mother has been careful 
to thoroughly scald the cow's milk by adding boiling water 
to it before giving it to her child, and constipation has fol- 
lowed its use, she should afterwards use warm instead of 
boiling water. This will likely correct the difficulty, for 
milk that has been boiled tends to restrain the bowels, while 
that which has not been heated has an opposite effect. 
Should the change be made and the bowels become too 
loose, the boiling water must again be used to dilute the 
milk. 

If the constipation continues in spite of the change of 
diet, it will be proper to move the bowels by artificial means. 
This can be done by introducing a small piece of castile 
soap into the bowel, as before directed, or by using injec- 
tions of warm water, to which a little melted lard or castor 
oil may be added. If the soap or the injections are resorted 
to, it will be best to gradually lengthen the intervals be- 
tween using them, with a view of aiding nature to overcome 
the constipation in a natural manner. 

Thus, if at first an injection is used every twenty-four 
hours, it may be well, after a few days, to use it once in thirty 
hours, and thus gradually increase^ the intervals until the 
bowels are moved without assistance. 

In very obstinate cases injections alone will not bo suffi- 
cient. They unload the lower bowels only, and in long-con- 



194 The Mother's Hand-Book. 

tinued cases it is essential that the whole intestinal tract be 
emptied. Therefore, once or twice a week, in addition to 
the injections, the child should have a dose of simple syrup 
of rhubarb, made according to the directions given in the 
article on " Medicines." 

SIMPLE DIARRHOEA. 

Diarrhoea in children is not uncommon, and may arise 
from a variety of causes. In some cases it is a very trifling 
disorder, while in others it may be the forerunner of some 
grave disease. 

Treatment. — Simple cases, such as are caused by over- 
feeding or nursing, when not attended by other symptoms 
of disease, can usually be relieved by paying attention 
to the diet and withdrawing a portion of the food at each 
meal. 

Some cases of diarrhoea are produced by the swallowing 
of food that is not digestible by the very young. Some ar- 
ticle placed into its hands by the nurse may have been 
swallowed, and the first intimation the mother has of any- 
thing wrong is restlessness and fret-fulness on the part of the 
child. In a little while it has a large, loose operation of the 
bowels, passing part of the food that has not been digested. 
The indigestible food should be gotten rid of as soon as pos- 
sible, and a small dose of castor oil should be given with 
this view. After it has acted, and the offending material 
has passed from the bowels, it will only be necessary to see 
that the child is kept quiet, and that its usual diet is re- 
stricted — not more than a, third or one-half being allowed 
it for twenty-four hours. 

If, after the castor oil has acted, there is a continuance of 
the diarrhoea, a few drops of Godfrey's Cordial, combined 
with a teaspoonful of aromatic syrup of rhubarb, may be 
given occasionally until the disease has been arrested. 



Diseases of the Stomach and Bowels. 195 



PERITONITIS 

[Erroneously called inflammation of the bowels). 

Peritonitis consists of an inflammation of the peritoneum — 
the serous membrane that lines the cavity of the abdo- 
men, and, being reflected over the intestines, constitutes 
their external covering. The inflammation may be limited 
to a small portion, or it may extend over the whole of the 
membrane. In the former case it is called local, and in the 
latter general peritonitis. The disease may exist as a pri- 
mary affection, or it may arise during the course of some 
other affection, when it is called secondary peritonitis. It 
may be either acute or chronic. Chronic peritonitis may 
succeed the acute form of the disease, or it may be tubercu- 
lar in character. In the latter form it is usually associ- 
ated with tubercular disease of the lungs or the bowels, or 
both. 

The term inflammation of the bowels is often incorrectly 
applied to this disease by non-professional persons. 

Acute peritonitis may be caused by sudden and severe ex- 
posure to cold — especially when the abdomen is not suffi- 
ciently protected by clothing. Blows and other injuries in- 
flicted upon the abdomen may produce the disease. Oftener, 
however, it depends upon perforation of the intestines. In 
rare instances, worms have forced their way through the in- 
testines into the peritoneal cavity, thus giving rise to peri- 
tonitis. 

Symptoms. — Peritonitis, due to exposure to cold, begins 
with a severe chill, followed by high fever and great tender- 
ness and pain in the abdomen. The abdominal walls soon 
become distended and excessively tender, the patient being 
unable to bear the slightest pressure. Even the bed-clot lies, 
by their weight, give him pain. Owing to the pain produced 
by the act, he is unable to extend his limbs, and lies on his 



196 The Mother's Hand-Book. 

back with his legs drawn up towards his body. This posi- 
tion of the body is significant of peritonitis. 

When, during the course of some other disease — such as 
typhoid fever — perforation of the bowel occurs, the accident 
is accompanied with an intense pain in the abdomen, fol- 
lowed, usually, by a severe chill or rigor. 

Vomiting is generally persistent during the course of an 
attack of peritonitis, and in the advanced stages the matters 
thrown up are of a bluish green color. When this symptom 
is present it usually indicates a fatal termination, as but few 
cases recover under such circumstances. 

The breathing in peritonitis is short, quick and superficial, 
owing to the fact that each inspiration forces the diaphragm 
down on the inflamed structures, thus causing an increase 
of the pain. 

The bowels are, as a rule, constipated, especially in the 
beginning of the disease; when diarrhoea is present it usually 
indicates that the peritonitis has a tubercular origin. 

Hiccough is a frequent and distressing symptom of the 
disease in its advanced stages. 

The pulse in peritonitis is small and quick, and towards 
the close of the disease it ceases at the wrist while the heart 
still acts. 

The temperature is not as high as in most other forms of 
inflammatory disease, and before death it usually sinks be- 
low the normal standard. 

As death approaches, the mind often remains unclouded, 
the patient being conscious of all that is going on around 
him. He is bathed in a cold sweat, while his skin, tongue 
and mouth are cold to the touch. The eyes are surrounded 
by dark, livid circles; the countenance is anxious and the 
voice is husky. A peculiar odor, like that from a dead body, 
is exhaled from the patient. 



Diseases of the Stomach and Bowels. 197 

Cases of mild or circumscribed peritonitis may end in re- 
covery; but when the disease involves all, or nearly all, of 
the peritoneum, death is nearly always the result. 

The treatment of peritonitis should be undertaken only by 
a competent physician. Even under the most favorable cir- 
cumstances but few recover from an attack of the disease, 
and whatever chance there may be to arrest its progress is 
confined to its initial stage. Before the arrival of the med- 
ical attendant the mother should place her child in bed and 
apply cloths, wrung from hot water, to the whole of its ab- 
domen. All kinds of food should be withheld from the pa- 
tient, but if thirsty he can have cold water in small quanti- 
ties at a time. 

The medical treatment of severe cases of peritonitis varies, 
to some extent, with the cause that produces the disease, and 
need not be alluded to in this article. 

WORMS. 

Of the different kinds of worms to which children are sub- 
ject, the long round-worm and the short thread-worm are 
the most frequent, Tape-worms are so seldom found in very 
young persons that it is deemed unnecessary to treat of them 
in this book. 

The symptoms produced by worms are various and often 
misleading, being such as are observed in irritation of the 
stomach and bowels from any cause. 

When a child is troubled with worms to any great extent 
it will have foul breath, a changeable appetite, occasional 
sickness at the stomach — perhaps vomiting — a swelled ab- 
domen, and during sleep it will be restless, and often awake 
in alarm. 

Worms may, by irritating the stomach and bowels, cause 
great disturbance of the nervous system, ending, sometimes, 
in convulsions. 



198 The Mother's Hand-Book. 

If suffering from thread-worms, which are seated in the 
lower bowel near its outlet, the child will be tormented with 
itching of the parts. 

It often happens that a child having quite a number of 
round-worms in its bowels shows no signs of their presence, 
but continues in the enjoyment of good health, and it is only 
when one is vomited or passed by stool that their presence 
is suspected. 

When from any cause the child becomes sick, the worms 
begin to wander from one part of the bowel to another, or 
perhaps get into the stomach, when, by irritating that organ, 
they produce vomiting. 

Such articles as unripe fruits, and meats not sufficiently 
cooked, may contain the germs from which worms are lib- 
erated in the stomach. The drinking of impure water, espe- 
cially that obtained from marshy or low-lying districts, may 
be the means of conveying the eggs to the system. Accord- 
ing to some authors, the eggs are frequently carried under 
the finger-nails of children, and thence they are easily trans- 
ferred to the mouth. 

Children that are subject to worms should drink but little 
milk, and syrups and other sweets should be strictly forbid- 
den them. When such articles are freely used the worms 
seem to multiply with great rapidity. 

In the treatment of children affected with worms, it is best 
not to use any of the patent vermifuges. Most of them are 
quite irritating to the mucous membrane of the stomach 
and bowels, and in excessive doses are liable to produce se- 
vere nervous symptoms. Besides, the long-continued use of 
such articles, by their injurious effect upon the stomach, 
may produce troublesome indigestion. Lozenges contain- 
ing santonine may not be liable to these objections, but they 
are so unreliable and uncertain in their action as to be un- 
worthy of a trial. 



Diseases of the Stomach and Bowels, 199 

The oil of wormseed is, perhaps, the safest and most reli- 
able remedy we have for the expulsion of the round-worm. 
It should be given in combination with glycerine and syrup 
of rhubarb. A child two years old may take three drops of 
the oil mixed with one-third of a teaspoonful of glycerine 
and one teaspoonful of the syrup of rhubarb or castor oil. 
If this medicine does not move the bowels freely, a dose of 
castor oil, to which five or six drops of turpentine have 
been added, should be given the next day to clear out the 
alimentary canal. 

The bad taste of the oil of wormseed sometimes renders 
it impossible to get a child to take or retain it. In such 
cases recourse should be had to santonine in doses of one to 
two grains for a child two years old. The santonine should 
be rubbed up with a small amount of white sugar and placed 
in the child's mouth, after which a little water may be given. 
The next day a dose of syrup of rhubarb or castor oil with 
a few drops of turpentine should be administered to act upon 
the bowels. 

The pink-root and senna mixture is an old remedy, and 
sometimes proves quite efficient. Take one-half ounce each of 
pink-root and senna, pour over them a pint of boiling water, 
and let it stand a few hours, after which it is ready for use. 
A tablespoonful can be given morning and night to a child two 
years old. After giving it for two or three days it should be 
suspended for awhile. 

The short thread-worms are situated in the lower bowel, 
and are quite difficult to get rid of. The ordinary remedies 
used for expelling the long round-worms have but little effect 
on the seat-worm. To remove them effectually it will be 
necessary, in addition to giving vermifuge as above directed, 
to resort to the use of injections. A pint of boiling water 
can be poured over a teaspoonful of powdered aloes, and 
after standing a few hours, one-fourth of it may be used as 



200 The Mother's Hand-Book. 

an injection, to be repeated each night until the whole of it 
has been used. If this does not serve the intended purpose, 
a mixture of equal parts of lime water and milk, or muci- 
lage of slippery elm, can be injected into the bowel. 

To allay the itching that is caused by seat-worms, a little 
calomel ointment (one-fourth of an even teaspoonful of calo- 
mel to a large tablespoonful of lard) should be rubbed on 
the parts and some of it inserted with the finger into the 
bowel. 

PROLAPSE OP THE BOWEL. 

Protrusion of the bowel from the fundament is caused by 
the straining that sometimes accompanies protracted diar- 
rhoea. This accident is very liable to happen in delicate 
children, whose muscles are weak and lax. The protrusion 
usually occurs while the child is straining at stool, and on 
being replaced it gives no further trouble until the next 
evacuation, when it again descends. In other cases the 
bowel does not keep its position after being returned, and 
falls of its own weight. Sometimes only a small part of the 
intestine protrudes from the orifice, while at other times the 
prolapsed portion may be three or four inches in length. 

While simple cases get well in a short time after the diar- 
rhoea ceases, others, of greater severity, may last for a long 
period even when properly treated. 

When the bowel descends independent of the child's 
straining at stool, it will be necessary, after returning it, to 
hold it in place by a compress, which should be supported 
by a bandage. Fold a piece of well-worn muslin into several 
layers half the size of the palm of the hand, grease it with 
fresh lard and place it against the fundament. Then 
fasten a strip of muslin, an inch and a half wide, around 
the body just above the hip bones. Fasten another strip, of 
the same size, to the back of the first, letting it pass between 



Diseases of the Stomach and Bowels. 201 

the limbs against the compress, and bring it up and secure 
it to the front of the strip that goes around the body. 

In mild cases the nurse can often prevent the bowel from 
descending by making pressure with the fingers, placed 
against the fundament, while the child is having an evacua- 
tion. 

The bowel, while it is down, should be bathed with a solu- 
tion of tannin (a large teaspoonful of tannin to a half pint 
of water), after which it can be returned by pressing against 
it with the fingers, or a soft rag well greased with fresh lard. 
After it has been replaced, a suppository made of one part 
of tannin to four of mutton tallow, and rolled into a ball the 
size of a buckshot, should be introduced a little way into 
the bowel. 

If judiciously managed, cases of prolapse of the bowel in 
children end in recovery. 



CHAPTER XIV. 



Diseases of tft£ Stomacft and Bo to sis 

(Continued)^ 



SUMMER COMPLAINT. 

UNDER the common name of summer complaint we shall 
treat, first, of cholera infantum; second, of ileo-colitis ; 
and, third, of summer diarrhoea. Some writers have consid- 
ered the above as distinctive diseases, and have devoted sep- 
arate articles to them. That this division is not necessary, 
however, is shown by the fact that not infrequently we meet 
with children that are at first attacked with symptoms of 
true cholera infantum, and under treatment the acute and 
graver symptoms subside, only to be followed in a few days 
by ileo-colitis, which, after awhile, is merged into a common 
infantile diarrhoea that lasts, in some cases, until the begin- 
ning of cold weather. 

Summer complaint is most prevalent during the second 
summer of infantile life, although children may suffer from it 
at a much earlier period. The worst cases usually occur at the 
time when the child is cutting its teeth. It prevails mostly 
during the hot weather of July and August, and many cases 
become worse when cool nights succeed the hot days of 
August. 

Cholera infantum usually comes on suddenly, although it 
is occasionally preceded by looseness of the bowels, which, 

[202] 7 



Diseases of the Stomach and Bowels. 203 

being neglected, terminates in the former disease. The at- 
tack, in most cases, commences with a profuse diarrhoea, 
which is soon followed by persistent vomiting. 

The vomiting and diarrhoea may be so severe as to cause 
the child in a few hours to lose all resemblance to its former 
self. The eyes are sunken and have a bluish line half en- 
circling their lower lids. The voice is altered, and the child 
utters incessant cries or moans. As the disease advances 
the cry may be shrill and piercing, caused by the brain 
becoming involved. The abdomen is shrunken; the skin 
is cold and has lost its tonicity, so that if pressed between 
the fingers the fold mad^ by the pressure will remain for 
several moments. 

The diarrhoea is usually profuse; the discharges being 
almost colorless, of a watery consistency, and having nume- 
rous white flakes floating in them. In other cases the stools 
are of a green or yellowish green color. The vomiting in- 
creases in severity, and all fluids are thrown up soon after 
being swallowed. The thirst is great, as is indicated by the 
child's cries, its impatience, and its alternately opening and 
closing its lips. 

If a tumbler containing water be placed near its mouth, 
it will raise its head and grasping the glass with avidity, 
carry it to its lips, and swallow the liquid, only to reject it 
in a few moments. 

As the disease progresses the pulse increases in rapidity, 
and the temperature continues to fall; the extremities, nose, 
chin, tongue and ears become cold. The countenance is of 
a leaden hue, and the features have a drawn appearance. 

Death may take place within a few hours after the begin- 
ning of the attack. Usually, however, the disease runs a 
more protracted course, and death does not occur until 
from three to six days after the commencement of the first 
symptoms. In such cases there is an elevation of tempera- 



204 The Mother's Hand-Booe:. 

ture; the skin becomes warmer, the abdomen tympanitic, 
the eyes red, the tongue red and dry. The child gradually 
falls into a stupor, which, with the upturned eyes, denotes 
that the brain has become affected. In this condition the 
child utters occasional sharp, shrill screams, such as are ob- 
served in diseases of the brain. Gradually it falls into a 
condition of complete stupor, death being preceded, in some 
cases, by convulsions. 

But all cases of cholera infantum do not end in death. 
Some, even of the most threatening character, may, with 
proper treatment, completely recover. Thus, instead of the 
symptoms growing from bad to worse, they may, after two 
or three days, assume a more favorable aspect. The diar- 
rhoea ceases to be so violent; the stools are less frequent, 
smaller in quantity and thicker in consistency. They con- 
tain more fecal matter, and have a more natural odor. The 
vomiting and thirst gradually subside. Food in small quan- 
tities can be taken and retained. The child, although thin 
and emaciated, is more natural in appearance, and, notwith- 
standing the continuance of a simple diarrhoea for a week 
or two, it may be restored to its usual health. 

More frequently, however, the disease passes into the 
second form of summer complaint — that is, ileo-colitis — in 
which condition there are small, frequent stools containing 
blood and mucus mixed with fecal matter. In such cases 
the disease is apt to run a protracted course, although it 
may finally end in complete recovery. 

Other cases of cholera infantum, after the acute stage has 
passed, assume the form of inflammatory diarrhoea without 
bloody stools, and, notwithstanding the disease is often pro- 
tracted, lasting, in some instances, until the following cool 
weather, it will, under careful management, usually termi- 
nate favorably. It should be remembered that in some 
cases a child having an attack of cholera infantum, fol- 



Diseases of the Stomach and Bowels. 205 

lowed by diarrhoea, is liable, during the continuance of the 
latter disease, to a return of the choleraic symptoms. Such 
a child should, therefore, be closely watched as long as it is 
the subject of diarrhoea in any form, no matter how slight, 
and no improper article of diet should be given it. The 
greatest care as to the hygienic surroundings must be taken, 
the object being to remove all causes that might in any way 
tend to rekindle the disease. 

Ileo-colitis consists of an inflammation of both the small 
and the large bowels, and may, as before stated, follow an 
attack of true cholera infantum. Oftener, however, it is a 
distinctive disease from the very beginning. 

At first the child is observed to be restless; it sighs and 
moans, and gives other evidence of being in pain during 
sleep. Its appetite is impaired, and if nursing, the milk, 
having an acid smell, is thrown up from the stomach. After 
a few days the characteristic diarrhoea, consisting mostly of 
blood and mucus, makes its appearance. 

Such are the ordinary symptoms of an acute attack; but 
in many cases ileo-colitis begins as a common diarrhoea, 
which continues several days before the discharges and 
other symptoms indicate the true nature of the malady. 

The diarrhoea is the most prominent and characteristic 
symptom of this disease. The frequency of the stools de- 
pends in a great measure on the severity of the attack. 
In cases with a moderate degree of inflammation of the 
bowels, the stools may not number over half a dozen during 
the twenty-four hours; while in a child with a high grade 
of inflammation they may average one per hour. The dis- 
charges vary greatly in amount, sometimes being small and 
mixed with blood and mucus; while in other cases they arc 
large, watery and almost colorless, depositing on the diaper 
undigested casein, which looks like putty. Sometimes the 
discharges have a bright green appearance when passed, but 



206 The Mother's Hand-Book. 

oftener the green color is not noticed until the diaper has 
been exposed to the air. When the stools contain much 
blood and mucus, the straining during each operation of 
the bowels is apt to be quite severe. 

As the disease progresses the bowels will often become 
distended with gases, causing severe paroxysmal pains. 
Loss of flesh and great debility rapidly take place, the mus- 
cles shrink, the skin becomes dry and wrinkled, the heart is 
weak, and the pulse is feeble. Vomiting is often distress- 
ing, and is accompanied with great nausea; the child is 
thirsty, and is unable to retain even cold water, unless given 
in very small quantities. Sometimes as the disease pro- 
gresses the vomiting ceases, or at least becomes less trouble- 
some. 

In many cases the acrid discharges from .the bowels pro- 
duce excoriations of the buttocks and thighs, giving the 
child great pain, and calling for special attention on the 
part of the nurse. 

In fatal cases the symptoms gradually increase in severity; 
the swelling or distention of the bowels is more marked; the 
stools are more frequent, consisting mainly of mucus, blood, 
and sometimes pus; the tongue is red and dry; the child 
becomes listless, and sleeps with its eye-lids only half closed, 
displaying the white of the eyes; while, from disturbance of 
the brain, convulsions may occur, ending speedily in death. 

If properly managed, most cases of ileo-colitis will end in 
recovery. In favorable cases, after an uncertain period, the 
symptoms gradually moderate. The number of stools di- 
minish; they become more natural in appearance and con- 
tain less blood and mucus, while the straining that accom- 
panies their discharge is not so great. The distention of the 
abdomen is not so marked, and pressure upon it is no longer 
painful. The vomiting gradually ceases and proper nour- 
ishment is retained. The fever subsides and the thirst 



Diseases op the Stomach and Bowels. 207 

abates. The child appears more natural, and begins to take 
an interest in surrounding objects. 

Instead, however, of rapid convalescence following an at- 
tack of acute ileo-colitis, the disease, even when recovery 
ultimately takes place, may assume a chronic form. In these 
cases the acute symptoms either pass away or are greatly 
modified. The fever entirely subsides, or becomes mild and 
less continuous. The diarrhoea is still present, but not so 
frequent or copious as in the acute stage, although mucus 
and blood may be found in the discharges, which usually re- 
main offensive to the smell. The tongue is generally moist 
and natural, and the appetite may be fair. The abdomen is 
more distended, and the walls are thin and relaxed. The 
child is fretful and also greatly emaciated, for, although it 
may take a reasonable amount of food, yet, owing to a lack of 
proper digestion and assimilation, it gains little or no flesh. 

Chronic ileo-colitis may run an indefinite course and end 
either in recovery or in death. In fatal cases the child dies of 
inanition, being completely worn out by the disease, or else 
some complication arises that hurries the case to a fatal issue. 
Sometimes thrush supervenes, and by interfering with the 
feeding and nourishment of* the patient, causes death. 

Diarrhoea, assuming a somewhat inflammatory character, 
may follow an attack of true cholera infantum, or it may 
begin as a simple diarrhoea without the choleraic symp- 
toms. When it begins as an acute disease, the child is 
peevish and fretful. At night its rest will be disturbed, 
the child starting and moaning as if in pain. Usually there 
is but little elevation of temperature, unless the disease as- 
sumes the form of ileo-colitis, when fever may be a promi- 
nent symptom. The mouth is dry, and there is considera- 
ble thirst. The tongue is slightly coated and the appetite is 
poor. Sometimes the stools are small, and contain fecaJ 
matter. At other times they are copious and watery, and 



208 The Mother's Hand-Book. 

have an offensive smell. The diapers usually contain white 
specks of undigested curd, and on exposure to air they be- 
come decidedly greenish in hue. The countenance is pale, 
and the eyes are somewhat sunken and hollow. The child 
rapidly loses flesh and becomes greatly emaciated. 

Favorable cases may terminate in complete restoration to 
health within a week or two, or convalescence may be pro- 
tracted until the approach of cool weather. Occasionally a 
child, during the existence of this form of diarrhoea, is sud- 
denly seized with true cholera infantum and may perish 
from that disease. In other cases it may, from error in diet, 
or other causes, be attacked by ileo-colitis, and present all 
the symptoms that belong to that complaint. 

Treatment of Cholera Infantum. — Careful nursing, with 
proper attention to the diet and the hygienic surroundings 
of the patient, are important factors in the management of 
cholera infantum. A child suffering from an attack of the 
disease should, without delay, be placed in a hot-water bath, 
to which a little mustard has been added. The object is to 
bring about a re-action and re-establish the circulation in 
the blood-vessels of the surface. To do this the child should 
be kept in the bath four or five minutes. Care must be taken 
that the water is not so warm or so strongly impregnated 
with mustard as to burn the child's tender skin. If the 
vomiting and excessive purging continue, and warmth is 
not restored to the skin, the bath can be repeated three or 
four times during the day. If, however, the child's surface 
becomes warm, and the vomiting and purging continue, the 
bath can be dispensed with, and a large mustard plaster, 
made as heretofore directed, by mixing mustard and flour 
with molasses, should be applied so as to cover the front of 
the chest and the abdomen. This can be kept on until it 
produces some irritation, when it should be removed, to be 
re-applied if necessary. 



Diseases of the Stomach axd Bowels. 200 

Attention should now be paid to the obstinate vomiting. 
No medicine has much effect upon this symptom, and the 
only one that promises any benefit at all is calomel, which 
may be given in doses not larger than a good-sized pin-head, 
mixed with a little white sugar and washed down with a 
teaspoonful of cold water. This may be repeated every two 
or three hours if the vomiting continues. 

In these cases the stomach must have rest; hence medi- 
cines and teas of various kinds, often recommended by inju- 
dicious friends, must not be given, and even cold water, the 
least objectionable of all liquids, must be allowed only in 
spoonful doses. On account of the intense thirst, the water 
should be given every few minutes, or else very small lumps of 
ice may be placed in the child's mouth to relieve the burning 
thirst. Milk, during the first stage of the disease, must not be 
allowed. Even if a child is nursing a mother that is in ordi- 
nary health, it must be weaned for the time being, and after 
recovery it can again be put to the breast. During the 
child's sickness the mother's breast should be artificially 
drawn to prevent the milk from drying up. 

It is usually taught that the mother's milk, being the natu- 
ral food for an infant, is the best nourishment it can take 
when it is sick. But when a child is taken suddenly ill with 
cholera infantum the mother's nervous system suffers a 
shock; she becomes nervous, anxious, and does not sleep 
well. Under such circumstances her milk rapidly under- 
goes a change in quality, rendering it so injurious to the sick 
child that but little improvement can be hoped for unless it 
is removed from the breast. 

Sometimes the mother refuses to even temporarily wean 
her child, and in such cases she may occasionally give as 
much as a spoonful of her milk to the infant, carefully watch- 
ing its effect. If reasonably well borne, it may be continued; 
but in all cases where vomiting and purging continue to any 
H 



210 The Mother's Hand-Book. 

great extent, the milk must be entirely withdrawn from the 
child until convalescence is established, after which it can 
take the breast without disturbing its stomach or bowels. 

When it is desirable to limit the quantity of milk taken at 
a time, it is best to draw the breast with a pump, or by other 
means, before the child is allowed to nurse. 

If the infant be very thirsty, it is best to give it a small 
spoonful of cold water before placing it to the breast. 

It is possible that, could a healthy wet-nurse be secured — 
one whose milk would remain unaffected by the child's sick- 
ness, and who took her usual amount of sleep and good 
food — the child might, with safety, be allowed to take small 
quantities of the breast-milk at a time. Good wet-nurses 
are, however, hard to secure, especially in country districts, 
and therefore the mother must find some artificial nourish- 
ment to take the place of her own milk — a food that will agree 
well with the patient, and that will not add to the vomiting 
and diarrhoea. 

While the vomiting is persistent, no attempt should be 
made to feed the child. No good can result from putting 
nourishment into its stomach under such circumstances, for 
it will be ejected in a few minutes. It is not the amount 
of food taken into its stomach that gives strength to the sys- 
tem, but the amount that is retained and digested. Hence, 
after the child has been taken from the breast, it may be 
some time before it will be safe to begin feeding it with 
artificial food, even in small quantities. 

Until such food can be borne, nothing but small pieces of 
ice placed in the mouth, and cold water, a teaspoonful at a 
time, should be allowed. 

After the vomiting has to a great extent ceased, artificial 
feeding may be resorted to, but in the most cautious and 
careful manner. At first a dessertspoonful of milk and water, 
or milk and barley water (prepared as directed in the article 



Diseases of the Stomach and Bowels. 211 

on " Nursing and Feeding") may be given by means of the 
nursing bottle. If it is thrown up in a few minutes, or if 
it passes off by the bowels in an undigested state, it should 
be discontinued, and recourse had to the cream and water 
mixture, or, what may be better, to the condensed milk, or 
Lacto-Preparata, or other infant food preparations alluded to 
in the article on "Nursing and Feeding," which contains 
full directions for the preparation and feeding of artificial 
foods. 

Whatever article may be selected under these circum- 
stances, only a very small quantity of it should be given at 
first; otherwise the vomiting and purging will most certainly 
return. By commencing with small quantities at a time, 
the stomach will gradually become accustomed to the pres- 
ence of food, and the quantity can be increased with safety. 
If, after commencing the use of artificial food, the case pro- 
gresses satisfactorily, no change should be made in the diet; 
but if a relapse occurs — the vomiting and purging return- 
ing — it is evident that the food disagrees with the child, and 
some change in its administration must be made. It has 
probably been given in quantities too large for the weak- 
ened stomach to digest, and all that is needed is to give less 
of it at a time, going back to a dessertspoonful until the 
stomach is able to digest larger quantities, when the amount 
may gradually be increased. 

Sometimes it is necessary to change the kind of food, as 
well as to reduce its quantity, and an intelligent mother will 
soon learn to manage these matters in* a satisfactory manner. 

But little has been said about giving medicines in this dis- 
ease, for the reason that most cases are better managed with- 
out the extensive use of drugs, and when they are indicated, 
no one but a physician should prescribe them. 

If a child be cutting teeth during an attack of summer 
complaint in any of its forms, the gums, if swollen and dark- 



212 The Mother's Hand-Book, 

colored, should be lanced, so as to allow the teeth to make 
their appearance without delay. 

The treatment of ileo-colitis, so far as the importance of 
proper feeding is concerned, does not materially differ from 
that of cholera infantum. In ileo-colitis the vomiting is not 
so persistent and the discharges from the bowels are not so 
large or exhausting as they are in cholera infantum; hence, 
children do not emaciate as fast in the former as. in the lat- 
ter disease. 

In many of these cases it is just as necessary to remove 
the child from its mother's breast as in cholera infantum. 

The successful management of ileo-colitis consists mainly 
in the proper nursing and feeding of the child. If one kind 
of artificial food disagrees, another should be tried, and small 
quantities only should be given at first, to be gradually in- 
creased as the child's stomach becomes able to retain and 
properly digest it. 

Sometimes a child afflicted with ileo-colitis passes consid- 
erable blood and mucus with the stools. If there is much 
straining it may be necessary to combat this symptom 
by the use of a drug. Although opium, in any form, should 
rarely be used in summer complaint, yet the straining at 
stool, in some cases, is best relieved by an injection containing 
three or four drops of laudanum to a dessertspoonful of very 
warm water, if the child is a year old. At six or eight 
months, two or three drops may be used. The injection 
should be given with a small syringe, taking care that no 
air is thrown into the bowel. After the injection a small cloth 
can be placed against the end of the bowel and pressure 
made with the hand for a few minutes to prevent the fluid 
from being returned. The injection may be repeated once 
or twice a day, care being taken not to employ it except when 
the straining and bloody stools clearly indicate the necessity 
for its use. 



Diseases of the Stomach and Bowels. 213 

If properly managed from the beginning, but few cases of 
ileo-colitis will become chronic ; but when such a result 
does occur a physician must be consulted and the child 
placed under his treatment. This form of summer com- 
plaint is liable to last for months, and requires great care and 
skill in its management. 

The treatment of diarrhoea, occurring during the process 
of teething, or following an attack of cholera infantum, con- 
sists mainly in properly regulating the child's diet. Most 
cases will recover without the use of drugs if carefully 
nursed and fed, and when the disease is severe medicines 
will have but little effect in curing it unless the feeding is 
properly attended to. When the vomiting and purging 
are obstinate the child will have to be taken from the 
mother's breast until these symptoms are controlled to a great 
degree. It should be placed on that kind of artificial diet that 
best agrees with it, and confined to a small quantity at a time 
until the stomach is able to retain and digest the food with- 
out trouble, when the quantity can be gradually increased. 
As the child improves, if the vomiting ceases and the dis- 
charges are less frequent and smaller in amount, the mo- 
ther may again place it to the breast, and if the milk agrees 
with it she can continue to let it nurse; but if the vomiting 
returns, or if the diarrhoea increases, it will be necessary to 
again give it artificial diet. In short, the rules governing 
the feeding of infants suffering from cholera infantum and 
ileo-colitis apply with equal force to those who have this 
form of diarrhoea. 

Occasionally, in spite of the most careful management, 
cases of diarrhoea assume a chronic form; the child, although 
much better than when first attacked, continuing to suffer 
more or less from the disease for a long time. In fact, in 
many cases, the trouble subsides only upon, the approach of 
cool weather, when the child begins to regain its health. 



214 The Mother's Hand-Book. 

strength and flesh, and in a little while it is as robust and 
strong as if it had never been the subject of disease. 

A child suffering from this, as well as from other forms 
of summer complaint, that does not seem to improve after 
careful attention has been paid to feeding and other hy- 
gienic measures, should be given over to the care of a phy- 
sician, in order that it may receive such medical treatment 
as will aid in restoring it to health. 

Thrush is sometimes met with during an attack of sum- 
mer complaint, and often proves not only troublesome, but 
dangerous to life, by interfering with the proper feeding and 
nourishment of the child; thus aiding in the fatal exhaus- 
tion that sometimes accompanies the latter disease. The 
reader is referred to the article on thrush, contained in an- 
other part of this book, for information in regard to the 
management of the affection. 

The excoriations on and about the buttocks, so often present 
in the different forms of summer complaint, and especially 
in ileo-colitis, require careful attention, as they are a source 
of suffering as well as danger to the child. 

These excoriations are produced by the urine and other 
acrid discharges coming in contact with the child's tender 
skin. The nurse should, therefore, see that the diapers are 
changed as soon as they are soiled, either by urine or the 
discharges from the bowels. When the diaper is removed 
the parts should be thoroughly cleansed by allowing warm 
water to flow over them from a sponge or cloth. No rub- 
bing must be allowed, but after the stream of warm water 
has washed away all the discharges, a soft cloth may be 
gently pressed against the parts to dry them. They can 
then be anointed with the oxide of zinc ointment, and a 
clean diaper applied. 

If the excoriations do not improve under this treatment, 
they should, after being washed with warm water, be bathed 



Diseases of the Stomach and Bowels. 215 

with a mixture consisting of a tablespoonful of alcohol and a 
half pint of water. A solution of sugar of lead — two even 
teaspoonfuls to a pint of water — is also a most valuable ap- 
plication, and may be used in place of the alcohol wash. 

In severe cases, instead of the oxide of zinc ointment, one 
made by mixing one-fourth of a teaspoonful of calomel with 
a tablespoonful of vaseline or lard, may be applied. This 
ointment, however, should be used with caution, and only in 
extreme cases, as there might be a possibility of its produc- 
ing salivation. 



CHAPTER XV. 



3?£tj£rs* 



EPHEMERAL FEVER. 

SOME children are peculiarly susceptible to attacks of 
fever from slight causes. After retiring at night in appa- 
rently good health, they are noticed before morning to be 
restless and feverish. 9 Usually they are thirsty, have head- 
ache, and their bowels are costive. The tongue is slightly 
coated, and there is but little desire for food. The child is 
rarely delirious, but it is nervous, and its muscles twitch 
while it is sleeping. 

Sometimes the attack comes on during the day-time; the 
child, ceasing to amuse itself at play and becoming drowsy, 
desires to be put to bed. In a day or two it is as well as 
ever, but in the course of a few weeks the same symptoms 
are observed, the child again becoming feverish, restless, and 
nervous. 

The liability to attacks of ephemeral fever may continue 
for a long time, but as the child grows older, and its diges- 
tive powers become stronger, the tendency to such attacks 
will cease. 

Children who are subject to this disease are usually deli- 
cate, of nervous temperament and slow growth. The at- 
tacks from which they suffer are supposed by their parents 
to be " bilious," or if they live in a locality where intermit- 
tent fever prevails, the trouble is supposed to be of malarial 

[216] 



Fevers. 217 

origin. In many cases the mother believes that her child 
suffers from worms. 

In nearly every case the cause of the disease should be 
sought for in the digestive organs. Those who suffer from 
ephemeral fever, as a rule, have a capricious appetite, and 
at times are prone to indulge in an excessive amount of 
food. They eat a great deal, but do not become fleshy. 
Owing to the patient's weak digestive powers, much of the 
food is not used in building up the system, but becomes 
irritating to the stomach and bowels. As a result of such 
irritation, fever occurs and the child is sick for the time 
being. 

But not only does an excessive amount of food taken by 
the child produce ephemeral fever, but sometimes the dis- 
ease is caused more by the quality than the quantity. Thus ; 
if the food is of an indigestible ■ nature, or of such char- 
acter as to readily undergo fermentation in the stomach, 
fever will likely result, even though the amount taken be 
small. 

Treatment. — In the management of this disease the first 
thing to do is to regulate the quantity and quality of the 
diet. Sufficient food that is nourishing and easily digested 
should be allowed at regular intervals, and the practice of 
eating between meals, so common among children, must not 
be permitted. Sweetmeats and all articles containing a 
large proportion of sugar should be avoided. The bowels 
ought to be kept regular, and for this purpose an occasional 
dose of the syrup of rhubarb may be given. 

At the commencement of an attack of ephemeral fever, a 
dose of mild purgative medicine should "be administered if 
the bowels are at all constipated, or if the child has par- 
taken of too much food, or of food of an improper kind. 
If the fever is at all severe a few drops of sweet spirits of 
nitre, mixed with a teaspoonful of water, can be given with 



218 The Mother's Hand-Book. 

advantage. The fever usually lasts but a day or two, and 
after its subsidence the child will be weak and languid, re- 
quiring rest and strict attention to its diet. 

During the intervals between the attacks of the disease 
the child's general health should be attended to. Plenty of 
outdoor exercise during good weather must be taken, and 
close and prolonged confinement in the house avoided. 

Tonics, combined with iron, given for weeks or months, 
will be of great benefit. A child two years old can take a 
half grain of the tartrate of iron and potash, mixed with 
eight drops of the tincture of colomba and a teaspoonful of 
water, three times a day. 

Eight or ten drops of the elixir of bark and iron, with a 
teaspoonful of water, given three times a day, forms an ex- 
cellent tonic for such cases. 

Although, as a rule, iron should always be given after 
meals, yet the above preparations, being non-irritating to the 
stomach, are best given before meal-time. 

INTERMITTENT FEVER AGUE. 

Intermittent fever is not infrequent among children who 
live in malarious districts. Children born of mothers who 
suffered from ague or intermittent fever during pregnancy 
are often afflicted with the disease from birth. In such cases 
the spleen and liver are enlarged, and the skin may have a 
yellowish hue, owing to the diseased condition of the blood. 
Such children never seem to be well. They are weak; usu- 
ally have a poor appetite and feeble digestive powers; their 
ability to resist disease is impaired, and they easily fall vic- 
tims to various acute affections. 

The germs that produce intermittent fever may lie dor- 
mant in the system for weeks or months. Sometimes per- 
sons, after living in a highly malarious district for years 
without having any manifestation of the disease, are at- 



Fevers. 219 

tacked with ague soon after moving to a country that is en- 
tirely free from malaria. 

Animals are not susceptible to the poison of ague. While 
but few human beings can expose themselves for any great 
length of time to its influence with impunity, animals liv- 
ing in the most pronounced malarial districts never become 
affected with the poison. 

Persons can reside in low, marshy districts in cold wea- 
ther without danger of contracting ague, and even during 
the rainy season, if the ground is submerged, there is but 
little danger of becoming affected. But when the water re- 
cedes, even if the ground is only partially exposed to the heat 
of the sun, the malarial poison becomes quite active. 

Again, even in elevated and dry regions similar results 
follow great disturbance of the soil that has not been stirred 
for a long period. Thus, in countries not highly malarious, 
the ploughing, during the warm season, of fields that have not 
been disturbed for many years, will often produce intermit- 
tent fever in those who live near by. In cities where the 
disease prevails in a mild form, the making and repairing 
of streets, as well as the digging of the ground to lay gas 
and water-pipes, often leads to a great increase of malarial 
diseases. 

Persons living in places where malaria abounds often suf- 
fer from enlargement of the liver and spleen after long-con- 
tinued attacks of ague. As a result of such organic changes 
the blood becomes affected, leading to a peculiar yellowish 
color of the skin, and sometimes to dropsy of the abdomen, 
the chest and the lower limbs. 

The yellowish hue of the skin and the enlargement of the 
liver and spleen are sometimes met with in infants born of 
mothers who have long suffered from malarial disease. 

A paroxysm of intermittent fever is composed of three 
distinct stages, called the cold, hot and sweating stages. 



220 The Mother's Hand-Book. 

The cold or shivering stage is characterized by an attack 
of shivering of more or less violence, lasting usually from 
a half hour to an hour or longer. The shivering begins in 
the lower part of the back and extends to other parts of the 
body. In some cases it is so mild that the patient can easily 
control the action of his muscles, while in others he loses 
such control, and his whole body becomes so agitated that he 
shakes the bed upon which he lies. There is intense thirst; 
the tongue is moist; the urine is scant and pale, and has the 
appearance of water; the appetite is lost, and nausea and 
vomiting are often present. 

The hot stage begins gradually by the shivering becoming 
more transient and alternating with warm flushings. The 
heat, which at first is slight, increases gradually until it 
is intense. The patient changes his position in bed fre- 
quently, hoping to find a cooler place upon which to rest. 
The headache increases, being, in some cases, almost un- 
bearable. The loss of appetite and the thirst continue; the 
urine is still scant, but has a deeper color. 

In the beginning of the sweating stage, the skin grad- 
ually becomes moist, the moisture increasing until the whole 
body is bathed in a profuse perspiration. The patient feels 
better, and his headache gradually disappears. The urine, 
red when passed, usually deposits, on cooling, a sediment the 
color of brick-dust. The fever gradually declines, and the 
pulse diminishes in frequency. 

After the paroxysm of fever terminates, the patient enjoys a 
period of comparatively good health until a return of the chill. 

Intermittent fever occasionally assumes a pernicious or 
congestive form in malarial districts during very wet sea- 
sons. At other times congestive chills are rarely met with, 
although intermittent fever may be prevailing extensively. 

In children, an attack of intermittent fever may commence 
with a convulsion instead of a chill. In other respects, 



Fevers. 221 

also, the symptoms of the disease in children differ some- 
what from those observed in adults; thus, the shivering is 
not so pronounced, being, in some cases, entirely absent or 
overlooked. Between the paroxysms of the disease the child 
is not so well — being fretful and somewhat feverish — as those 
who have intermittent fever in adult life. Besides, the dis- 
ease in childhood is more obscure and the paroxysms are 
not as regular as later in life. 

Children living in malarious districts often exhibit signs 
of ill-health without suffering from actual attacks of fever. 
Such patients are thin of flesh and weakly. Their skin has 
an unhealthy appearance, being of a pale yellowish color ; 
their appetite is poor, and their bowels are irregular. In 
rare cases there may be swelling of the lower limbs and 
other signs of general dropsy. 

These symptoms may depend upon the changed condition 
of the blood, or disease of the kidneys, caused by chronic 
malarial poisoning. 

Treatment. — Quinine is the principal remedy used in the 
treatment of intermittent fever. It is well borne by the 
young, and a child one year old can take one grain four or 
five times a day until relieved. The quinine should be 
dissolved in ten or twelve drops of sweet spirits of nitre 
and given ' in a teaspoonful of syrup of ginger or orange 
peel. 

After the fever has been arrested the quinine can be con- 
tinued in grain doses twice a week until the child has re- 
gained its usual health. 

If possible, a child affected with chronic ague should be 
removed to a place that is free from malaria. 

If the quinine is not retained by the stomach, the diffi- 
culty can sometimes be overcome by the application of mus- 
tard over the front part of the abdomen and chest before 
giving the medicine. 



222 The Mother's Hand-Book. 

The bowels should be kept open, and for this purpose the 
syrup of rhubarb may be given in full doses. 

During the hot stage the fever can be moderated by ad- 
ministering sweet spirits of nitre in suitable doses every two 
or three hours. 

Cold cloths applied to the forehead, and bathing the body 
and limbs with tepid water, will be soothing and beneficial. 

The thirst should be allayed by giving cold water in small 
quantities as often as may be necessary. 

The diet must be nourishing and easy of digestion, and 
partaken of in small quantities at a time. 

Since intermittent fever in children is often complicated 
with enlargement of the liver and spleen, as well as other 
diseased conditions of the system, it is essential that each case 
should, when possible, be treated by a competent physician. 

INFANTILE REMITTENT FEVER TYPHOID FEVER. 

Fifty years ago medical writers held that typhoid fever 
was limited to adult life, and never occurred in childhood. 
Later writers, however, consider the disease known to the 
old authors as infantile remittent fever to be true typhoid 
fever. That the essential features are the same is not 
doubted; but in children the disease presents certain pecu- 
liarities that do not belong to the typhoid fever of adults, 
and hence we prefer to treat of it under the old name of 
infantile remittent fever. 

Causes. — The disease is slightly contagious; but most cases 
are caused by absorption into the system of a specific poison 
generated by the decomposing discharges of typhoid pa- 
tients, and largely disseminated by emanations from privies, 
cesspools and other places where such discharges are de- 
posited. The disease cannot be contracted by inhaling the 
breath or the emanations from the skin of typhoid patients. 
The patient's discharges are supposed to be harmless when 



Fevers. 223 

first passed, but after standing until putrefaction begins 
they become dangerous. The poison is received into the 
system through the air-passages and the alimentary canal. 
In the latter case the diseased germs enter the body most 
usually through the medium of impure drinking-water. In 
some cases the disease is caused by drinking milk that has 
been contaminated by the addition of water containing the 
germs of typhoid fever. The disease may also arise from 
inhaling sewer-gas that has escaped from waste-pipes in 
houses where the plumbing is defective. 

In infantile remittent fever, Peyer's glands, situated in the 
small intestine, are swollen and ulcerated. The associated 
mesenteric glands are also involved, being enlarged and 
softened. In favorable cases the ulcerated glands heal in 
the course of two or three weeks; but in many fatal cases 
the ulcerative action extends until it perforates the coats of 
the intestine, permitting its contents to escape into the peri- 
toneal cavity. The kidneys are sometimes in a state of con- 
gestion; the mucous membrane of the air-passages is usually 
red and congested, while pneumonia of a low grade is occa- 
sionally present. 

Symptoms. — The disease begins to manifest itself within 
ten to fourteen days after the poison has been received into 
the system. The fever begins so gradually that it is difficult 
to fix the precise date of its commencement. Usually the 
child complains of headache, is languid, and has but little 
appetite. The tongue is covered with a thick white fur, 
through which little red points are seen. The bowels at this 
stage of the disease are sometimes confined, at others rather 
loose — one or two offensive stools being passed each day. 
The child is stupid and drowsy, often complaining of pain 
in the head, body and limbs. During the first week of the 
disease the patient may not take to his bed voluntarily, but 
insist on being up and around the house. 



224 The Mother's Hand-Book. 

At the end of a week the symptoms become more pro- 
nounced. The abdomen is swollen and pressure upon it 
produces pain. The bowels contain gases, which; by moving 
from one part of the intestines to another, cause a gurgling 
sound. The bowels may be constipated, although diarrhoea 
is usually present, the discharges having the color of yellow 
ochre. 

After awhile the headache subsides and the patient be- 
comes delirious at night. He lies quietly on. his back and 
takes but little notice of things around him. His cheeks 
are flushed with fever, and frequent draughts of cold water 
are required to allay his thirst. The pulse varies greatly in 
different cases, sometimes being only moderately accelerated, 
while at others it is greatly increased in frequency. There 
is usually a difference of from two to three degrees in the 
morning and evening temperature, it being about 101° to 
102° in the morning and 104° to 105° in the evening: 

As the disease progresses, the cough often becomes trou- 
blesome, depending, in many cases, upon inter-current bron- 
chitis or pneumonia, which is apt to occur during the course 
of typhoid fever. 

During the second week of the disease the pulse increases 
in frequency, and the child becomes weaker. The abdomen 
is greatly swollen, and gives a hollow sound when tapped 
upon. The diarrhoea increases, and the discharges some- 
times contain blood. The patient's indifference to surround- 
ing objects is more marked; he sleeps most of the time 
during the day, and at night he is restless and delirious. 
About this time twitching of the tendons of the muscles of 
the wrist is noticed. 

In mild cases the fever begins to diminish at the begin- 
ning of the third week, the temperature in the morning be- 
ing, perhaps, but little above the normal standard, while in 
the evening it rises two or three degrees. Although ex- 



Fevers. 225 

tremely weak, the child begins to show signs of improve- 
ment. His countenance is less dull, and the abdomen is 
not so swollen and tense. The diarrhoea is not so trouble- 
some, and the discharges are more natural. 

In some cases of infantile remittent fever the symptoms 
are severe from the start. Occasionally the disease com- 
mences with a chill; but usually the initial symptoms con- 
sist of fever, headache, languor and drowsiness. The sleep 
is disturbed, the child often crying out as if in pain, or else 
talking incoherently. The fever is high; the skin dry and 
pungently hot. The tongue soon becomes red and dry, the 
abdomen swollen and tender, while, in most cases, diarrhoea 
is persistent. 

As the disease progresses all the symptoms become inten- 
sified; the discharges from the bowels are passed without 
the patient's knowledge; the lips and teeth are coated with 
a dark, dirty deposit (sordes), while the tongue is dry, tremu- 
lous, and covered with dark-brown crusts. 

Even from this condition the patient may recover; but, 
owing to his extreme debility, it will require several weeks 
for him to regain his usual flesh and strength. 

In fatal cases the symptoms at the beginning of the third 
week, instead of gradually yielding, become intensified. 
The disturbance of the nervous system is more marked; 
the twitching of the muscles is increased, and the patient 
sinks into a deep stupor, which is interrupted by violent 
delirium and efforts to get out of bed. The abdomen 
is greatly swollen, the stools are frequent, are passed in- 
voluntarily, and at times contain blood. The respirations 
are hurried and noisy, and towards the close of the disease 
the patient picks at the bedclothes and at imaginary objects 
in the air. 

In mild cases the tongue may be moist during the whole 
course of the disease. Oftener, however, as the fever pro- 
x 5 



226 The Mother's Hand-Book. 

gresses, the tongue becomes dry — the dryness beginning at 
the tip and sides and gradually spreading over the whole 
surface. Further along in tne course of the disease the 
tongue is extremely dry, harsh to the touch and deeply 
cracked or fissured. Sordes, or black, sticky mucus, collects 
on the teeth and gums, while the lips are parched and cracked, 
with dark scales adhering to them. 

Throughout the disease the urine is scant and high-col- 
ored, and in the worst cases it is passed without the patient's 
knowledge. 

The skin is usually hot and dry, but sometimes it is moist, 
and in favorable cases, during the third week there may be 
copious perspiration. 

Infantile remittent fever in its earlier stages may be mis- 
taken for some other disease. In childhood many diseases 
begin with symptoms so much alike that it may be impossi- 
ble in some cases to establish a positive diagnosis during the 
first few days. If a child is noticed to be dull and languid, 
with a fever that is high in the evening and two or three 
degrees lower the next morning for several days, without 
the symptoms that belong to disease of any of the impor- 
tant organs of the body, we may suspect the existence of 
infantile remittent fever. If, in addition to the above de- 
scribed symptoms, the patient has a swollen and tender ab- 
domen, with a tendency to diarrhoea, our suspicions are 
almost confirmed. In making out a diagnosis of infantile 
remittent fever, care must be taken to exclude tubercular 
disease of the brain, bowels and lungs. Acute catarrh of 
the stomach and inflammatory diarrhoea may also be mis- 
taken for the disease under consideration. 

Infantile remittent fever, although always a serious and 
often a dangerous disease, is not attended with as high a 
death-rate as might be expected, considering its protracted 
course and the severity of its symptoms. Most cases re- 



Fevers. 227 

cover, provided skillful medical assistance is obtained in 
the beginning of the disease. When death occurs it is usu- 
ally due to peritonitis, the result of perforation following 
deep-seated ulceration of the bowels. Sometimes bronchitis 
or pneumonia intervene during the course of infantile re- 
mittent fever, and, by interfering with respiration, may pro- 
duce death in cases that would otherwise end in recovery. 

Treatment. — Every case of infantile remittent fever should 
be placed in charge of a medical practitioner without delay. 
Although excessive drugging is worse than no treatment 
at all, yet the safety of the patient depends upon careful 
watching, good nursing, proper feeding, and the adoption 
of remedies suitable to meet the various complications that 
may arise during the course of the disease. But the mo- 
ther will have much to do in the way of feeding and nurs- 
ing her child under the physician's directions. 

Unless the water used for drinking purposes is known to 
be pure, it should be boiled and allowed to cool before it is 
given to the patient. 

The child should be placed in bed at once, and absolute 
rest must be insisted upon. If possible, the room should 
be separated from others that are occupied by the rest of the 
family — one in the upper part of the house being preferred. 
The room should be large and properly ventilated, the tem- 
perature being kept as near 66° as possible. The patient 
should be covered with light bedclothes, sufficiently warm 
to prevent chilliness, while a night-shirt, made of fine white 
flannel, should be worn next to the body. 

All discharges from the bowels must be disinfected and 
taken from the room soon after being passed, and sheets, 
cloths, and other articles that have been soiled must be 
treated in the same manner. 

Cold water, sufficient to allay thirst, should be given in 
small quantities at a time, as often as may be necessary. 



228 The Mother's Hand-Book. 

From the beginning of the disease until the child has 
fully^ recovered, care must be exercised in regard to the 
diet. No article that is irritating to the stomach or bowels, 
or difficult of digestion, or that leaves a large residuum after 
being digested, should be allowed. Cases of typhoid fever 
have been lost during convalescence by a disregard of this 
injunction. In this disease the little glands of the bowels 
(Peyer's glands) are ulcerated, and although during conva- 
lescence they are in a condition of repair, yet their struc- 
ture is extremely delicate and easily injured. The passage 
of irritating and undigested food and excrementitious mat- 
ters over them is liable to cause perforation of the bowels, 
which in nearly all cases is followed by death. All articles 
that are liable to undergo fermentation and form acid should 
be avoided. Farinaceous articles, and fruits of all kinds, 
had better not be given. 

The patient should take his nourishment in a liquid or 
semi-liquid form. Of all the articles adapted to the nour- 
ishment of a person with typhoid fever, milk, when well 
borne, is the most important. It is highly nutritious, easily 
digested, and leaves but little residuum to disturb the ulcers 
along the course of the bowels. If the child is young, an 
equal part of barley water, boiling hot, should be added to 
the milk to prevent the formation of large lumps of curd in 
the stomach. 

When the milk is not well borne, or when the child be- 
comes tired of it, recourse should be had to strong beef es- 
sence, or to one of the infant-food preparations. 

In this disease nourishment should be taken in prescribed 
doses and at stated intervals. The quantity of food and the 
time for giving it must be regulated by the age of the patient 
and the condition of his digestive organs. If over-fed, nausea, 
restlessness, increased fever, and possibly increased diar- 
rhoea, will result. 



Fevers. 229 

In the beginning of infantile remittent fever, the mistake 
is often made of giving the child too much purgative medi- 
cine. While a single dose of castor oil, or syrup of rhubarb, 
may be useful, the repetition of the purgative two or three 
times will most likely add to the patient's danger by aug- 
menting the disease of the bowels and increasing the diar- 
rhoea. 

During the progress of the disease many symptoms may 
arise that will require the administration of medicines to 
combat; but such matters must be left solely to the judg- 
ment of the physician who has charge of the case. Although 
simple cases of this disease require but little medicine in 
their treatment, yet various complications may occur that 
will render active medication necessary. 

Diarrhoea may sometimes be so persistent and exhaustive 
as to call for special remedies for its amelioration. These 
should be of a simple nature, and given in small doses. 
The use of strong astringent medicines to suddenly check 
the bowels must be avoided, as they invariably add to the 
existing disease of the intestines. 

If hemorrhage from the bowels be profuse, strong astrin- 
gents may be required; but no one save a physician should 
prescribe them. 

A person suffering from typhoid fever should not be al- 
lowed to sit upon a vessel while having an operation on the 
bowels, or assume an upright position for any purpose what- 
ever, until the physician has given him permission to do so. 
A disregard of this caution may lead to perforation of the 
bowels, followed by speedy death. 



CHAPTER XVI. 



33ertJOtts Diseases. 



COXVTJLSIOXS. 



CONVULSIONS may be caused by disease situated in the 
brain itself, or by disturbances in other parts of the 
body acting upon the brain through the nervous system. 
When caused by disease of the brain, they usually indicate 
a fatal result, but recovery may be looked for in most cases 
that are produced by reflex action — i. e., from irritation in 
other parts of the body. 

Convulsions occur at a very early period in congestion of 
the brain, and are usually preceded by great drowsiness, 
vomiting, and pain in the head. 

In tubercular disease of the brain, convulsions will, in 
some cases, attack a child seemingly without warning; but a 
careful inquiry into the case will often disclose the fact that for 
some time previous to the seizure the child was dull, drowsy, 
without much appetite, and had constipated bowels, accom- 
panied, most likely, with headache. 

Convulsions may also happen during the progress of 
various acute diseases, such as whooping-cough, scarlet 
fever, measles, etc. 

If the child is affected with diarrhoea during 'the process 
of teething, it is liable to have convulsions. In such 
cases the trouble may result either from the irritation pro- 
duced by a tooth pressing upon a swollen gum, or from the 

[230] 



Nervous Diseases. 231 

exhaustive diarrhoea producing disturbance of the circula- 
tion in the brain, or from both. 

One of the most frequent causes of convulsions in chil- 
dren is the over-loading of the stomach with indigestible 
food. I have known death to follow the eating of grapes, 
the skin and seed producing sufficient irritation to cause 
fatal convulsions. 

Obstinate constipation, by locking up the irritating con- 
tents of the bowels, may give rise to convulsive attacks in 
children. 

The presence of worms in the stomach or bowels may 
cause convulsive seizures. 

In exceptional cases, a child may have a stone in the kid- 
ney, which, by changing its position in that organ, may pro- 
duce sufficient pain and irritation to cause convulsions. In 
the only case of the kind that I have seen, the urine con- 
tained blood both before and after the convulsive seizure. 

At the beginning of a convulsive attack the muscles of the 
face twitch, while the body is stiff and immovable. In a short 
time the head, with a twitching motion, is drawn backwards; 
the limbs jerk, being violently flexed and extended; the eyes 
are fixed and do not see; the breathing is hurried, labored and 
irregular, and the skin is bathed in a profuse perspiration. 
After this condition has lasted a minute or two, or perhaps 
longer, the convulsion ceases; the child either falls asleep, or 
lies for a short time in a dazed condition and then bursts into 
crying. Sometimes it sinks into profound sleep, which may 
be quiet or attended with slight twitching of the muscles, or, 
lastly, it may die in the convulsive attack. Occasionally, when 
the convulsion depends upon disease of the brain, certain 
musciea of only one side of the body are affected. 

The treatment of these cases must be conducted by a phy- 
sician, but pending his arrival the mother should not be 
idle. The child should be placed in a warm bath as soon as 



232 The Mother's Hand-Book. 

possible. If it is known that its stomach contains indiges- 
tible food, a quick emetic ought to be given it at once. For 
this purpose the ipecac, either in powder or syrup, will be 
safe and effective. After vomiting has taken place, an in- 
jection of warm water, or the administration of a dose of 
castor oil, will serve to clear out the contents of the bowels. 

If the convulsion is caused by retention of fecal matter, 
an injection of warm water and lard should be used without 
delay, to be quickly followed by a dose of castor oil. 

If the child's gums are badly swollen and painful, they 
must be lanced at once. 

If convulsions are caused by worms in the stomach or 
bowels, a dose of the oil of wormseed in glycerine and cas- 
tor oil should be given as soon as possible, and a mixture of 
turpentine and lard rubbed on the child's abdomen. 

When convulsions are produced by grave disease of the 
brain or kidneys, or when they occur upon the non-appear- 
ance or the recession of an eruption in certain acute diseases 
of the skin, as scarlet fever and measles, the efforts of the 
mother should be confined to the use of the warm-water 
bath and securing quiet and plenty of air for her child. 
The medical treatment should be conducted only by a phy- 
sician who understands the cause of the disease and how to 
apply the remedies best suited to each individual case. 

CHOREA, OR ST. VITUS' DANCE. 

St. Vitus' dance is not a frequent disease of very early 
childhood, though occasionally cases have been met with in 
children under four years of age. 

The disease usually comes on gradually, unless it is caused 
by a sudden shock, as from fright, a fall, a blow, etc., when 
it may arise suddenly. 

Before the peculiar movements of St. Vitus' dance are 
noticed, the child is usually out of health. Its temper 



Nervous Diseases. 233 

changes; it is sad, and becomes capricious and easily agi- 
tated; it is irritable, seeks solitude, and keeps away from its 
playmates. Its memory is not retentive, and it is incapable 
of fixing its attention long on any subject. It usually com- 
plains of headache and pains in the limbs; the appetite di- 
minishes, and digestion becomes disordered. 

The child is inclined to be constantly moving from place 
to place, and is uneasy unless its limbs are in constant mo- 
tion. Afterwards it has awkward, fidgety movements, which 
are limited to one side of the body, and are beyond self-con- 
trol. At first the arm is affected, and afterwards the leg be- 
comes involved, causing the child to stumble and fall occa- 
sionally when walking. In a little while the movements 
extend to the other side of the body, and the muscles of the 
face participating in the disease cause the child to make 
the strangest grimaces. Voluntary control over the hands 
is so much impaired that when attempting to grasp anything 
the patient makes several attempts, frequently missing the 
object, and at last, seizing it convulsively, drops or flings it 
away. 

In some severe cases the muscles of the leg are so much 
affected that the patient cannot walk or even stand alone. 
The tongue is protruded with difficulty, and with a jerking 
motion, rendering it difficult for the physician to examine 
it. The speech is stammering and almost unintelligible, 
and swallowing is difficult and performed with spasmodic 
gulps. The muscular twitching may continue even when 
the child is lying in bed. In very bad cases, if long con- 
tinued, the intellect is dulled, the manner and expression 
becoming almost idiotic. 

Sometimes the malady never passes beyond the mild 
form, consisting of an inability to hold objects in the hand, 
to keep the arms from occasionally twitching, and to pre- 
vent the momentary jerking of the face and head. 



234 The Mother's Hand-Book. 

Death from chorea is extremely rare, and when it does 
happen it is from exhaustion, the result of the continued 
and violent movements of the body. But, although chorea 
seldom causes death, yet it is a disease exceedingly difficult 
to cure, and is liable to run quite a protracted course. 

Some cases recover in about a month, while others may 
last several months, or even a year or two, the average dura- 
tion being about seventy days. After a supposed recovery 
it is not unusual for the disease to return. The relapse may 
happen soon, or it may occur months or years after the pa- 
tient has been, to all appearances, well of the disease. These 
recurrences may take place several times; but each attack is 
usually milder than the preceding one. 

The medical treatment of St. Vitus' dance must be left to 
the physician, but much can be done by the mother to has- 
ten the cure. 

AVhen the exciting cause of the disease is known, it must be 
removed, if possible, and in all cases the greatest care must 
be paid to the patient's general health. Exercise in the 
open air, and plenty of such food as agrees with the pa- 
tient and is easily digested, must be insisted upon. Gym- 
nastic exercises have an excellent effect upon choreic cases, 
and skipping the rope is one of the best exercises that can 
be employed. Warm salt-water baths, followed by gentle 
rubbing of the body, is a useful measure. 

It is of the first importance that the patient should not 
have his attention called to his disease. Many cases are 
made chronic, and the cure greatly delayed, by the discour- 
aging remarks of injudicious persons. The malady is painted 
in heightened colors, and useless and unnecessary sympathy 
is expressed to the patient. Sometimes cruel and brutal 
companions ridicule his infirmity, thus causing him to 
lose control to a still greater degree over his jerking mus- 
cles. 



Nervous Diseases. 235 

Patients with this disease should be encouraged to make 
every exertion to direct the movements of the limbs, and 
they should be assured that they are making progress to- 
wards recovery. It must be instilled into their minds that 
they are sure to get well in the end, and that much can be 
done by the exercise of their will towards overcoming the 
infirmity. 

LARYNGISMUS STRIDULUS, OR CHILD-CROWING. 

This is a somewhat rare complaint, and occurs only in 
very early life. It is most frequently seen during the period 
when the child is cutting its teeth, but it may happen before 
or after that event. The disease is of nervous origin and is 
not attended with fever. It is characterized by crowing in- 
spirations and a temporary suspension of breathing. The 
cough and the voice are not hoarse as in croup. As the 
disease progresses it becomes associated with other convul- 
sive symptoms, as crossed eyes, drawing in of the fingers 
upon the hands and of the toes on the bottoms of the feet, 
and general convulsions. 

In some cases, laryngismus stridulus is caused by irri- 
tation and debility produced by teething, while in others it 
arises from digestive disorders dependent upon improper 
food. Various other causes may also give rise to the disease. 
While it is most usually met with in nervous children who 
are feeble and of scrofulous or rickety constitution, it may 
also attack those who seem to be robust and healthy. Dur- 
ing the period of teething the nervous system is in an irri- 
table and excitable state, and hence causes that at other 
times might not appreciably affect the child may, under 
these conditions, lead to convulsive attacks. 

The disease usually comes on by degrees, the child, loses 
its appetite and is fretful during the day and restless at 
night, presenting many ill-defined symptoms usually as- 



236 The Mother's Hand-Book. 

cribed to teething. After these symptoms have lasted a few 
days, or a week, a slight crowing sound is occasionally heard 
with the child's respiration. This is first noticed when the 
infant awakes from sleep, or during a spell of crying, or 
when it is nursing. The sound usually increases in inten- 
sity in proportion to its frequency. The attacks may occur 
either in the day-time or at night, but they are more fre- 
quent during the latter period. 

At first the child's general health may not be perceptibly 
affected during the intervals between the attacks ; but it will 
not be long before the symptoms become graver and give 
rise to great alarm. Sometimes the disease begins suddenly, 
and before the parents have noticed any departure from or- 
dinary health, the child is seized with a paroxysm of diffi- 
cult breathing; the larynx closing spasmodically, prevents 
the air from entering the lungs in full quantities. As the air 
reaches the lungs through a small aperture, a crowing sound 
during inspiration is produced, giving rise to the name of the 
disease. Owing to the difficulty of getting its breath, the 
child's body is thrown backwards, while its eyes are fixed and 
staring and its nostrils are widely dilated. If the paroxysm 
continues a few seconds the face becomes livid, the extremities 
cold, and the fingers are drawn in on the palms of the hands 
and the toes on the soles of the feet. After a few seconds, 
or a minute or more, the spasm ceases, the child takes a 
full inspiration, bursts out crying and soon regains its natu- 
ral appearance; or, if the fit has been very severe, it may 
return slowly to its natural condition, being drowsy and lan- 
guid for awhile. If the disease continues to progress, the 
fingers, toes, arms and legs become permanently contracted, 
and the child may die in convulsions. 

The disease may terminate fatally in a short time, or it may 
continue, at intervals, for weeks or months, ending finally 
either in death or in recoverv. 



Nervous Diseases. 237 

The only disease with which laryngismus stridulus is 
likely to be confounded is false croup. Indeed, some writers 
make this mistake. In false croup, hoarseness and cough 
are marked symptoms; in the crowing disease they are ab- 
sent. The fact that the paroxysms come on in the day- 
time as well as at night, and that they are accompanied by 
spasms of the fingers, toes and other parts of the body, also 
serves to distinguish it from false croup. 

The treatment consists, first, in removing, when possible, 
the cause that gave rise to the disease. In infants, before 
teething, the trouble is usually produced by over-feeding, or 
by food of an improper kind. If, therefore, the child is 
nursing the mother's breast, the quantity taken at a time 
must be restricted; and if the disease continues, it is pro- 
bable that the mother's milk does not agree with the infant, 
in which case it should be taken from the breast and given 
artificial food. If the child is not taking the mother's milk, 
but is being fed with some other nourishment, a change 
must be made, and the infant placed on that kind of food 
that is found to agree with it best. The chapter on " Nurs- 
ing and Feeding" contains full directions for preparing the 
different kinds of infant foods. 

The state of the bowels must be inquired into, and if con- 
stipation exists a mild purgative, such as castor oil or syrup 
of rhubarb, can be given. If the bowels have to be moved 
very often by artificial means, it is best to use occasionally 
an injection of warm water to obviate the necessity of giv- 
ing a purgative too frequently. An occasional warm-water 
bath, followed by gentle friction over the stomach and bow- 
els with the warm hand, will be beneficial. 

If the child is cutting its teeth, and if the gums are ten- 
der and swollen, they must be freely lanced, in order to re- 
lieve the irritation of the nervous system produced by the 
congested gum. 



238 The Mother's Hand-Book. 

As any sudden excitement may cause a paroxysm of the 
disease, it is important that all sources of annoyance he ex- 
cluded from the sick-room, so that the child may rest qui- 
etly and without disturbance. While the room must be well 
ventilated, no draught of air should be permitted to pass over 
the child's body, as the impression of sudden cold on the 
surface may be sufficient to produce a convulsive seizure. 
During the paroxysm but little can be done to mitigate the 
severity of the attack. A little spirits may be sprinkled on 
the face and chest, and the feet placed in warm water, with, 
perhaps, some hope of abbreviating the duration of the 
paroxysm. 

The treatment of this disease by medicine should be un- 
dertaken only by a physician having a good knowledge of 
his profession. 

CEREBRO-SPINAL MENINGITIS, OR SPOTTED FEVER. 

This is an epidemic disease and is caused by inflammation 
of the membranes of the brain and the spinal cord. 

The disease usually begins suddenly, the person being in 
apparent good health until seized with one or more symp- 
toms of the malady. In other cases the patient, if old 
enough, may complain of wandering pains and other mani- 
festations of impaired health before spinal meningitis is sus- 
pected. Usually the first marked symptoms are headache 
and vomiting, followed by a severe rigor, or " shake," if the 
patient be an adult. If the attack occurs in a young child 
the headache and vomiting may be followed by a convulsion 
instead of a rigor. After the fit the child is usually dull, 
stupid and restless, while the moaning and crying, with fre- 
quent carrying of the hand to the head, indicate that it is 
suffering with headache. The pupils are sometimes dilated, 
at others contracted. The bowels are usually constipated. 
The pulse is quick and often irregular. The surface of the 



Nervous Diseases. 239 

body is extremely sensitive, the slightest pressure sometimes 
causing the patient to moan or scream. 

Retraction of the head upon the shoulders is the most 
marked symptom of cerebro-spinal meningitis, and usually 
occurs soon after the patient is attacked with the disease. 
Not only is the head drawn back upon the shoulder, but in 
some severe cases the muscles all along the spine are vio- 
lently contracted, thus bending the whole body backward. 
Sometimes the jaws are rigidly closed, and this condition of 
lock-jaw may continue until death. The muscles engaged 
in the act of swallowing may become paralyzed almost at 
the commencement of the disease, rendering it impossible 
to take food or medicine in the natural way. 

When the disease is at its height the child lies on its side 
with its head retracted, its body bent backward, and its limbs 
fixed. In fatal cases the symptoms usually continue with- 
out abatement, consciousness is lost, the cries and other 
manifestations of pain cease, and the child falls into a stu- 
por from which it cannot be aroused. Occasionally, a few 
days before death, the patient seems to be much better and 
brighter. Consciousness may, to some extent, return, but 
only for a short time. This seeming improvement is calcu- 
lated to deceive the parents, and even the physician may be 
misled by it. Attention in such cases should be j)aid to the 
condition of the pupils. In temporary improvement they will 
be found either abnormally contracted or dilated, and the 
stimulus of light will have but little, if any, effect upon them ; 
on the other hand, if the improvement is permanent the 
pupils will usually respond to the action of light. 

Different epidemics of cerebro-spinal meningitis differ in 
their fatality. During the prevalence of some, a majority of 
persons attacked succumb to the disease, while in others the 
mortality is not so great — a vast majority of eases recover- 
ing. Cases occurring at the beginning of an epidemic are 



240 , The Mother's Hand-Book. 

usually more fatal than those happening at a later stage. 
At first the disease may assume the fulminating form, over- 
whelming the patient within a few hours after the first symp- 
toms are noticed. As the epidemic progresses, however, the 
specific poison seems to become attenuated, and the disease 
usually assumes a much milder form. 

Sometimes, though not often, an eruption appears upon 
the skin, and on account of its presence the disease has been 
called " spotted fever." The rash consists of dark purple 
spots, or blotches, due to extravasation of blood under the 
skin. They are usually found on the legs, hands, face, back 
and neck, and in size they may range from a pin's head to 
a walnut; generally, however, they are about as large as a 
five-cent piece. 

Paralysis may, during the course of the disease, affect the 
muscles of the throat to such an extent as to render swal- 
lowing impossible, or one or both of the lower limbs may 
be implicated. This form of paralysis seems to be incura- 
ble, no remedy having any effect upon it. 

The duration of the disease is variable. In its most ma- 
lignant form death may take place within a few hours from 
the beginning of the attack. Other cases are more pro- 
tracted, lasting five or six weeks, and ending either in death 
or in recovery. Convalescence is always slow, the resulting 
debility continuing a long time. 

The treatment of cerebro-spinal meningitis is very unsatis- 
factory. Different writers have recommended remedies of 
the most opposite character. The fact is that many cases 
will die, no matter what treatment is adopted, while others 
will recover with but little medication, if properly nursed 
and judiciously fed. In the very beginning, if no physician 
is present, the mother may, if the child's bowels are con- 
stipated, give a dose of purgative medicine, such as castor 
oil or syrup of rhubarb. If the child has excessive head- 



Nervous Diseases. 241 

ache, and especially if it is threatened with convulsions, a 
hot-water bath should be given at once. This may be re- 
peated occasionally, if required, until a physician can be 
procured to take charge of the case. The patient should be 
kept in a room that is dark and well ventilated. 

HICCOUGH, OR HICCUP. 

This troublesome and annoying affection may occur in 
both children and adults. Any irritation of the phrenic 
nerve at its origin, along its course, or at its terminal 
branches, which are situated on the under side of the dia- 
phragm, may produce hiccough. Undue distention of the 
stomach by being overfilled with food or drink, or by an ac- 
cumulation of wind due to faulty digestion, is the most com- 
mon cause of hiccough. In some persons the introduction 
into the stomach of hot, peppery foods may give rise to the 
affection. 

Hiccough is occasionally a troublesome symptom during 
convalescence in cholera, and is attended with eructations of 
wind and sometimes with vomiting. 

Persistent hiccough occurring during the course of typhoid 
fever is often an indication of perforation of the bowels and 
the onset of general peritonitis, being in such cases a fatal 
symptom. 

The treatment of hiccough will depend upon the cause that 
produces the disease. Thus, if it proceeds from over-disten- 
tion of the stomach, a mild emetic will often give relief. Tak- 
ing a full breath and distending the lungs for a few moments 
seems to produce such an impression upon the diaphragm 
as to cause a suspension of the hiccough in some cases. 

The application of hot cloths over the stomach will occa- 
sionally be useful. 

In cases of nervous origin, in children, relief is sometimes 
obtained by diverting the patient's attention from his trou- 
16 



242 The Mother's Hand-Book. 

ble, and telling him of some thrilling or startling occur- 
rence. 

A glass of water, swallowed as hot as can be borne, will 
occasionally arrest a paroxysm of hiccough. 

The medicines used in the treatment of severe cases are 
dangerous unless given in suitable doses and at proper in- 
tervals; hence, when the above-mentioned measures fail to 
give relief, and the trouble continues to such an extent as to 
disturb the patient's rest, a physician should be summoned. 

NIGHT TERRORS. 

A child in otherwise seemingly good health may suffer 
from night terrors. Soon after going to sleep it wakes up 
suddenly, frightened and terrified. It screams violently and 
declares that it has seen a ghost, or some other frightful ob- 
ject, on or near its bed. The child is the picture of terror 
and alarm; the perspiration streams down its face, and it 
may be from fifteen to thirty minutes before it becomes paci- 
fied. Sometimes it is attacked with a fit of weeping, and 
sobs itself to sleep in its mother's arms. It usually has but 
one attack during a night, but occasionally it may wake 
several times with the terrors. The trouble is apt to recur 
night after night for an indefinite period. 

Night terrors seem to be a species of nightmare, and are 
apt to occur at the time when a child is cutting its perma- 
nent teeth. They do not indicate disease of the brain; but 
are associated with some derangement of the digestive organs, 
such as indigestion or dyspepsia. In such cases the child 
is badly nourished; has irregular bowels, and its stools 
usually contain large quantities of mucus. 

Although the malady is not caused by brain disease, yet 
every effort should be made to restore the child to a healthy 
condition, as a frequent and long-continued repetition of the 
terrors, and the excitement produced by them, may at length 
produce serious disease of the nervous centres. 



Nervous Diseases. 243 

In the treatment of these cases it is important that the 
child's surroundings be pleasant, and that nothing shall 
occur to worry or fret, and especially to alarm it. It must 
not be talked to about ghosts, mad dogs, and such horrify- 
ing things. 

Its surroundings during the day should be as pleasant as 
possible, so that its thoughts will not be centred on objects 
of terror and alarm when it retires at night. A light should 
be left in its room during the night, and it is best that an 
older person should occupy a bed in the same room. Warm 
baths, before retiring, will be soothing to its nervous system 
and tend to induce sleep. 

The diet should consist of such articles as are nourishing 
and easily digested. Potatoes, puddings, cakes, and all kiuds 
of sweets, must be excluded. Two hours after each meal the 
child should take six or eight grains of bicarbonate of soda 
(common baking soda) in a teaspoonful of water. 

The evening meal should be taken early — say three or four 
hours before retiring. An occasional dose of laxative medi- 
cine, such as syrup of rhubarb, or calcined magnesia, will 
be beneficial. 



CHAPTER XVII, 



Constitutional ©iseases. 



CONSUMPTION. 

IN most cases of consumption in children the disease is 
inherited. Occasionally, however, it is acquired in early 
childhood, owing to bad hygienic surroundings and impro- 
per nourishment. It is also probable that consumption is 
produced by the reception into the system of the peculiar 
bacillus, or microbe, that is supposed to cause the disease 
in those who would not otherwise suffer from it. Whether 
the presence of this bacillus is the principal cause of con- 
sumption is questionable; but it is nevertheless certain that 
in nearly all cases it is present in some of the affected tis- 
sues. Besides, it is found in the matters expectorated by 
consumptive patients. When the expectoration is deposited 
on carpets or other articles and left to dry, the germ that 
produces the disease will soon be found floating in the air 
of the room, whence it is inspired by others, with the possi- 
ble effect of inoculating them with the virus. 

While active exercise — within reasonable limits — and 
plenty of pure fresh air, with good nutritious food, consti- 
tute the principal safeguards against consumption, the in- 
fectious character of the disease must not be overlooked, 
and hence those children that are born of consumptive pa- 
rents must be removed as far as possible from contact with 
tuberculous persons. That a husband may contract the dis- 

[244] 



Constitutional Diseases. 245 

ease from a consumptive wife, or that a healthy wife may 
fall a victim to tuberculosis from her intimate association 
with a consumptive husband, are facts that come within the 
observation of many persons. This being the case, a mo- 
ment's thought will convince any one of the necessity of 
placing a child in the care of a nurse that is entirely free of 
tubercular disease. If the mother is consumptive the child 
must be cared for by a healthy nurse; and where other 
members of the family are suffering from the disease the 
child should, in a measure, be isolated from them — at least 
they should not be permitted to nurse, kiss, or handle it to 
any extent, nor should they blow their breath on its food to 
cool it, nor sleep in the same room with it. 

As matters expectorated by consumptive patients contain 
the germs that produce consumption, and are therefore in- 
fectious, they should be destroyed without delay. This can 
easily be done by having the patient deposit the expectora- 
tions upon small bits of paper, after which they should be 
thrown into the fire. No consumptive should allow his ex- 
pectorated matter to be deposited on the floor, or bedclothes, 
or other article, where it will remain long in the room. 

Occasionally it happens that a mother far gone with con- 
sumption becomes pregnant, and during the time of her 
pregnancy the lung disease seems to be suspended, her 
health becoming greatly improved after conception. At the 
end of her term she gives birth to a child that is plump, 
well nourished, and looking healthy. The temporary arrest 
of the disease in the mother has had a salutary effect upon 
the child, and it comes into the world seemingly with a fair 
chance of permanent good health. Under such circum- 
stances the mother must not permit the child to nurse her 
breasts, for such a course would not only hasten her own 
death, but, being confined to the milk of a consumptive mo- 
ther, the child would most likely die before completing the 



246 The Mother's Hand-Book. 

process of teething, or, if it should safely pass that danger- 
ous period, it would continue to be a weak, badly-nourished 
being, of low vitality, and incapable of withstanding fatigue 
and exposure. 

In grown persons the tubercular deposit nearly always 
begins in the lungs, and when it exists in other organs it is 
as a secondary deposit — an extension, as it were, of the lung 
disease. In childhood the deposit may occur in various tis- 
sues of the body, such as the lungs, the bronchial glands, 
mesenteric glands, the intestines, the brain, and various 
other structures. 

The symptoms of consumption in childhood differ to a con- 
siderable extent from those observed in adult life. Thus, 
in childhood, bleeding from the lungs is not common; the 
cough is comparatively slight; the expectoration is not very 
profuse, and the. exhausting night-sweats are rarely present. 
For some weeks before the cough excites apprehension that 
the lungs are affected, the child complains of pains in its 
chest and abdomen; it loses its appetite, and its strength 
and flesh gradually fail. It is listless and fretful in day-time, 
and as night approaches the skin becomes dry and hot, and 
the lips parched, showing an accession of fever. The cough, 
although it may be frequent, is slight, short and dry. These 
symptoms may all be present in other diseases; but when 
they occur in a child born of consumptive parents they are 
always a matter of alarm, especially if the patient loses flesh 
and strength, and has a temperature constantly above the 
normal standard. 

If bronchitis supervenes, which is likely to happen, the 
symptoms become aggravated; the respiration is quick and 
accompanied with wheezing; the cough is more frequent 
and lasts longer; mucus is secreted in large quantities, and 
is coughed up or swallowed. Sweating, if present, instead 
of being profuse and exhaustive, is generally limited to the 



Constitutional Diseases. 247 

face and head. In some eases, diarrhoea, attended with 
great wasting of the body, occurs, and a deposit resembling 
thrush is seen inside of the mouth. If the tubercles are 
deposited in the bronchial glands, the breathing becomes 
more difficult, because of the pressure made by the enlarged 
glands upon the air-tubes. In such cases the wheezing is 
increased and the face is puffed and swollen. 

In the treatment of children born of consumptive parents, 
as well as others in whom there is a tendency to the disease, 
efforts must from the first be made to surround them with 
the best sanitary conditions possible. 

Unhealthy mothers must not suckle their children, but 
the best substitute for her milk must be employed. If cow's 
milk is used it must be drawn from a healthy animal; or if 
it is impossible to secure milk from an animal known to be 
healthy, it should be boiled for five minutes before it is 
given to the infant. To feed a young child milk from a tu- 
berculous cow would only aid in the production of the dis- 
ease. As the child grows older other articles can be added 
to its diet. After the first few months one of the " infant 
foods" can be given with advantage; and after the comple- 
tion of the first year tender meats, eggs, and vegetables in 
their season, will constitute important additions to the child's 
dietary. 

Articles containing an excess of sugar and starch should 
be excluded, for the reason that they are apt to produce an 
acid condition of the stomach and bowels, greatly interfer- 
ing with digestion and assimilation. To give sweetmeats 
instead of meat, eggs and milk, is to substitute food contain- 
ing very little nourishment for that which tends to give tone 
and vigor to a system already weakened by disease. Fur- 
thermore, the excessive secretion of acid that attends the 
ingestion of sweets, impairs the appetite and renders it 
impossible to give a sufficient quantity of more nourishing 



248 The Mother's Hand-Book. 

food. If the appetite becomes poor, and the child is not in- 
clined to take a sufficient amount of nourishment, it may be 
allowed a little wine at meal-time, diluted with equal parts 
of water. The precise kind of food best adapted to each 
case can be determined only by actual trial cautiously made. 

The clothing should be kept light and warm, and the child 
should be taken out-doors quite often, if the weather is fair. 

Salt-water bathing is of great value in the management 
of consumptive children. While the child is young, it will 
be sufficient to wet a large sponge with the salt water at a 
temperature a little below that of the body, and to apply it 
to the whole surface. With a soft cloth the child should be 
carefully dried, and the body rubbed with the hand until 
the skin is aglow. This operation can be completed in two 
or three minutes, and should be performed every morning. 
As the child becomes older it can take a regular salt-water 
bath for a few minutes, and afterwards rub itself perfectly 
dry with a coarse cloth or towel, which should be firmly and 
briskly applied to the skin. 

Children who are threatened with consumption should 
not be kept too close at their studies. The ordinary school- 
room, with its bad ventilation and changeable temperature, 
is not a suitable place for a delicate child. Besides, such 
rooms are usually crowded with children, some of whom may 
be the subjects of disease of an infectious character, and 
the constant breathing of the vitiated atmosphere of the room 
is dangerous even to the strong, and often fatal to the weak. 

The rooms of a consumptive patient must be thoroughly 
aired during the day-time. To keep them closed night and 
day is to imperil the health not only of the patient, but also 
of other members of the household. 

If possible, the parents should take the child to a climate 
suitable for the residence of a consumptive person. Chil- 
dren who, in many localities, would die of consumption in 



Constitutional Diseases. 249 

early life, may live to old age in a mild, dry climate with an 
even temperature, and free from malaria and other poison- 
ous and depressing agencies. If the parents reside in a low, 
wet place, with ponds or marshes near, and if it is impossi- 
ble to change their residence to a more genial climate, much 
good can be accomplished by selecting an elevated location 
near by. By moving their residence to a higher locality 
they will escape the evil influence of malarial poisoning, and 
secure for themselves and their children better air and more 
desirable hygienic surroundings. 

The choice of an occupation for the child to follow in after- 
life is a most important matter. In making such a selection, 
the principal aim should be to choose a vocation that will 
lead to plenty of out-door exercise. A moderate amount of 
daily physical exertion is necessary, but hard and exhaus- 
tive manual labor must be avoided. The strength of the 
muscles should be increased by daily use, but exhaustion 
from hard work must be guarded against. Exercise, with- 
out putting too much strain on any of the vital organs, and 
not carried to the point of fatigue, should be the guide under 
such circumstances. Sedentary occupations and confine- 
ment to in-door positions, such as book-keeping, clerking, 
etc., are not suitable to those who are tainted with consump- 
tive or scrofulous disease. 



SCROFULA. 

Scrofula, in a child, is usually hereditary, but it may be 
acquired by the constant action of causes that depress the 
general health. The offspring of very old persons are more 
apt to be scrofulous than those who are born of parents that 
are in the enjoyment of the health and vitality that belong 
to early and middle life. 

That a close kinship exists between scrofula and consump- 
tion is shown by the fact that scrofulous children are often 



250 The Mother's Hand-Book. 

the issue of consumptive parents, while consumptive chil- 
dren are not infrequently the offspring of those who suffer 
from scrofula. 

The peculiar bacillus, or minute organism, that produces 
consumption, or at least that is found in the tuberculous 
matter of consumptive persons, is also sometimes, but not 
always, present in scrofulous textures. 

But even if the causation be nearly identical, the symp- 
toms attending the two diseases are quite dissimilar. Thus, 
while consumption, in a vast majority of cases expends its 
force on the lungs, scrofula affects the lymphatic glands, the 
skin, bones, joints, eyes, and mucous membranes. 

Inflammation of a gland in a sound child runs a different 
course from that which it pursues in a scrofulous one. In 
the former, if properly treated, it will often end in resolu- 
tion or cure, without the formation of matter, and when 
suppuration does take place the matter will be discovered in 
a comparatively short time. In the scrofulous patient, how- 
ever, the gland will continue in an inflamed condition for a 
long time, being hard, greatly swollen, and perhaps nodu- 
lated, with but little tendency either to the formation of mat- 
ter, or to cure by resolution. In fact, it continues in pretty 
much the same condition for a long time. When matter 
forms in such glands it is always slow in its development, 
and when it finds an exit, either by lancing or b} T ulcerating 
through the skin, the abscess is hard to heal and continues 
to secrete thin, unhealthy matter for a long time. 

Scrofulous inflammation of the eyes is stubborn, pro- 
tracted and difficult of cure. Specks, or opacities, appear 
upon the front of the eye-ball, which may seriously interfere 
with sight. Intolerance of light is a marked symptom, it 
being almost impossible to separate the eye-lids unless the 
room be darkened. Scrofula frequently manifests itself in 
inflammation of the eye-lids. This form of the disease is 



Constitutional Diseases. 251 

apt to follow an attack of measles in a scrofulous child, and 
is a most troublesome and long-continued affection. The 
eye-lashes become involved, some of them falling out, while 
others are turned in upon the eye-ball, keeping it constantly 
irritated. The disease may last for a life-time, at times giv- 
ing rise to but little inconvenience, while under the influ- 
ence of an exciting cause it may recur with all its former 
violence. 

Diseases of the bones constitute one of the gravest mani- 
festations of the scrofulous taint. Various kinds of curva- 
tures of the spine, hip-joint disease, and abscesses of bones 
in other portions of the body, arise from causes that in 
healthy individuals would lead to no such dreadful results. 

The skin of scrofulous children is often the seat of ulcers 
and sores that are hard to heal, being but little benefited 
by remedies that in the healthy would soon accomplish 
a cure. The mucous membrane of the throat and nose is 
frequently the seat of the scrofulous affection. The disease 
becomes chronic, and is attended with the secretion of a 
sticky, stringy matter that runs from the child's nose, and 
by its abundant quantity interferes with natural breath- 
ing. 

Irritation of the stomach and bowels, with vomiting and 
diarrhoea, the result of exposure to cold, is attended with 
fever in children who have scrofula, while in the healthy the 
same amount of derangement of the digestive organs would 
not produce any febrile action 

Very young children are, in a measure, exempt from at- 
tacks of scrofula; but after the second year it becomes some- 
what common, and from that age until the child is fourteen 
or fifteen years old, the. disease is very active. 

Acquired scrofula, or that form of the disease not depend- 
ing upon heredity, may arise from causes that interfere with 
the healthy development of the system during the first 



252 The Mother's Hand-Book. 

years of childhood. Improper nourishment in early life 
may have much to do in developing the disease. If the 
mother's system is tainted, her milk will contribute to the 
impairment of the infant's health. The germs contained in 
milk from tuberculous cows may also aid in producing 
scrofula. Exposure to an atmosphere vitiated by the pro- 
ducts of decomposition in unclean houses, may be a potent 
factor in causing the disease. 

The treatment consists mainly in doing everything possi- 
ble to build up the child's system and to increase its strength, 
thus enabling it to resist those influences that are potent in 
the production of scrofula. The general measures adapted 
to this purpose have been given in the article on consump- 
tion, to which the reader is referred. 

Medicines have but little effect in the prevention or cure 
of scrofula. When indicated it is because of some compli- 
cation that is either present or prospective, and, of course, 
under such circumstances, no one but a physician should 
prescribe them. 

If the mother is healthy, and her milk agrees with the in- 
fant, weaning can be somewhat deferred, and the child should 
be given a mixed diet before it is taken from the breast. As 
it grows older its diet should be varied and not confined to 
a few articles of food only. But while such articles should 
form the basis of the child's diet, indulgence must be per- 
mitted in others, so that it will not become tired of the food 
upon which we place the most reliance. While milk, eggs 
and good beef will constitute the principal items that enter 
into its dietary, as it advances in age different kinds of vege- 
tables that suit its appetite and are easily digested should 
be allowed in moderation. Good fresh bread to suit its taste 
may be given in such quantities as it may desire; but if 
bread made from corn meal be relished by the child, it should 
be preferred to wheat bread for the dinner meal, while for 



Constitutional Diseases. 253 

supper oat-nieal mush will be an excellent addition to the 
bill of fare. 

Salt-water sponge baths are beneficial, and should be used 
in early life a little warmer than the temperature of the 
room. As the child becomes older the water need not be so 
warm. 

Enlargement of the glands of the neck, so often met with 
in scrofulous children, requires but little treatment by the 
mother. The tincture of iodine is often painted on the skin 
covering the gland, but it is doubtful whether it answers any 
useful purpose. If the glands are painfully swollen some re- 
lief may be given by frequent applications of warm sweet 
oil, which can be gently rubbed into the skin with the hand. 

Scrofulous inflammation of the eyes should be treated by 
a competent ophthalmic surgeon. The mother should see 
that the child's eyes are not exposed to the rays of light, 
and that they are kept clean by frequently bathing them in 
warm water. 

In scrofulous affections of the nose and throat, the parts 
must be kept as free as possible from acrid secretions by the 
use of warm-water gargles to the throat, and the application 
of a wash of alcohol and water to the nose by means of a 
camel's-hair brush. 

Sores, ulcers and eruptions upon the skin should be fre- 
quently bathed to keep them clean, and to remove the foul 
secretions to which they give rise. 

Cases of spinal curvature, hip-joint disease, and all affec- 
tions of the bones must be placed in charge of a skillful sur- 
geon as soon as they are suspected. Time in such cases is 
all-important; the delay of a few days may cost the sufferer 
the use of a limb, and possibly life itself may be compro- 
mised. In these cases the mother's attention should he 
given to the prevention of injuries to the child by falls or 
other accidents. 



254 The Mother's Hand-Book. 

rickets. 

Rickets is a disease of early childhood, beginning, usu- 
ally, between the fourth month and the second year. Chil- 
dren affected with the disease are usually the offspring of 
scrofulous parents; but cases may occur where there is no 
hereditary taint in the family. 

Rickets consists essentially of a change in the constitu- 
ents of the bones; the hard or cancellated structure being 
partly removed, while the softer portion largely predomi- 
nates. This explains why the bones, having lost the mine- 
ral matter which gives them hardness, become so soft and 
are so easily bent by any pressure that is exerted upon them. 
Although all the bones are affected in this disease, it is ob- 
vious that those which are subjected to strong muscular ac- 
tion, or have to sustain considerable weight, will suffer most. 
We therefore find the spine, the pelvis, and the lower limbs 
most prominently distorted. The spine may be bent for- 
ward, causing hump-back, or it may bend towards the side, 
constituting lateral curvature. The lower limbs are crooked, 
usually caused by an increase of their natural curves; or 
they may be bent in a variety of shapes. Arrest of growth 
in the limbs is marked, giving the child a dwarfish appear- 
ance. The ribs follow the distortion of the spine, and owing 
to their change of position and the bending forward of the 
breast bone, a sharp prominence of the chest is produced. 
The abdomen is usually prominent; the stature is stunted, 
dwarfish and unseemly. The head may be below the nor- 
mal size, yet, because of the deficiency in the size of the 
bones of the face, it may have the appearance of being un- 
naturally large. The features are marked; the general ex- 
pression of the face is displeasing and of a character pecu- 
liar to this disease. 

It may be impossible to detect rickets in its very earliest 
stages. The first symptoms are connected with the organs 



Constitutional Diseases. 255 

of digestion, and may be present during the course of many 
chronic diseases. The discharges from the bowels are light 
in color, due to an absence of bile, and are offensive to the 
smell. The appetite may be absent, or capricious, and vom- 
iting may occasionally occur. The child grows dull, is pee- 
vish, and there is wasting of the body. 

The deformity produced by rickets is often first discovered 
when the child attempts to walk. The knees approach each 
other closely, while the ankles are widely separated; the 
shins curve forwards over the ankles. The deformity is al- 
together different from the bow-leg or bandy-leg curve that 
may happen in perfectly healthy children. After the lower 
limbs begin to bend out of shape, the spinal column soon 
yields to the pressure upon it, and a curvature is quickly es- 
tablished. After this the other bones become affected, show- 
ing that the disease, so far as the bone affection is concerned, 
is general in character. The number of bones involved 
serves to distinguish the spinal curvature produced by rick- 
ets from curvatures occurring in those who are free from 
constitutional diseases. 

Curvatures of the spine, not due to rickets, are usually 
seen in young persons after the tenth or twelfth year, while 
rickety curvatures take place in the very young. Non- 
rickety spinal curvature is usually met with in the well-to- 
do young female, and is not accompanied by deformity of 
the pelvis, or lower limbs; rickety curvature, on the other 
hand, happens in the poor and badly-nourished child, and 
is attended with such deformities, and also with a seeming 
enlargement of the head. 

A child suffering from rickets may succumb to some of the 
various complications that are liable to supervene during 
the progress of the disease, such as bronchitis, pneumonia, 
or water on the brain, ending in convulsions, or to disease 
of the lymphatic glands, producing irremediable changes in 



256 The Mother's Hand-Book. 

the blood. Protracted diarrhoea with ulceration of the glands 
of the bowels may also exhaust the rickety patient and pro- 
duce a fatal result. 

Ordinarily rickets is essentially a chronic disease and lasts 
for months or years, the deformity being permanent. As 
the patient advances in age the disease does not become 
more marked; but at or about puberty, sometimes before, 
the proportion of earthy matters is restored to the bones, 
the general health improves, the flesh and color become 
good, while digestion and assimilation approach a normal 
standard. In favorable cases, much of the deformity may 
have been overcome by proper treatment; but it usually hap- 
pens that, although the patient has regained his general 
health, he remains a permanent misshapen dwarf. 

Treatment. — As rickets is usually caused by defective nu- 
trition, and a lack of good wholesome food, it is of the first 
importance in its management to provide the patient with 
nutritious diet, pure air, warm clothing and frequent baths. 
If the mother's milk is rich and agrees with the child, it is 
the best article of diet; but if it is very poor in quality, or 
if it disagrees with the child's stomach and bowels, the con- 
densed milk, or some of the infant foods, should be substi- 
tuted. In this connection the article on feeding can be con- 
sulted with advantage. 

As the child grows older a little beef-broth with bread can 
be given. After the eighth month, eggs, beef twice a day, 
and strong soup, in small quantities, should be allowed. If 
no ordinary article of diet agrees with the child, or if it con- 
tinues to emaciate, it should, if over eighteen months old, 
be given raw beef. The beef must be lean and tender, free 
from fat and gristle, and should be cut into very fine parti- 
cles, and then rubbed through a colencler. It should then 
be well seasoned with salt and rolled into little balls, and 
fed in small quantities. As animal matter is deficient in 



Constitutional Diseases. 257 

the bones of rickety patients, the raw beef as a diet is 
peculiarly adapted to the needs of such persons. Of course, 
if the raw meat disagrees it must be discontinued. 

Cod-liver oil is of great value in the treatment of children 
who suffer from rickets. It should be combined with equal 
parts of syrup of phosphate of iron and lime water. These 
three articles can be mixed in equal quantities, and, after 
being well shaken, a teaspoonful may be given to the child 
three times a day. If this mixture is well borne it can be 
continued for a long time, but if it disagrees with the stom- 
ach and bowels to any great extent, it should be withdrawn, 
and dependence must be placed on such nourishing food as 
agrees well with the child. 

The patient must be taken into the out-door air each 
day during pleasant weather; but it should not be carried in 
the nurse's arms, as by doing so the tendency to deformity 
might be increased. A small child can be taken out-doors 
in a basket provided with a soft but firm pad for it to lie on. 
When older, it can be placed in a hand-carriage provided 
with a soft bed. 

The regular sleep should be taken on a soft mattress, and 
not on a feather-bed. High pillows must be avoided, as 
tending to increase deformities. In short, the child should 
lie in such manner as will not cause the body to bend in an 
unnatural curvature at any one point. It should not be 
made to stand on its feet, or even allowed to sit upright, as 
such positions tend to the formation of curvatures by the 
super-imposed weight upon the soft and yielding bones. 
Daily bathing the child with salt water, followed by gentle 
rubbing of the body, is of value in giving tone and strength 
to the system. 

The patient must be warmly clad, flannel being worn both 
winter and summer. Instead of changing the clothing from 
woollen to cotton goods as the warm weather approaches, it 
17 



258 The Mother's Hand-Book. 

is better to change from a thick to a thin article of flannel. 
In winter the flannel should be of some thickness, so as to 
insure sufficient warmth to the body, while in warm weather 
it should be of the lightest possible texture. 

The rectification of deformities occasioned by rickets be- 
longs to the domain of surgery, and need not be treated of 
in these pages. 



CHAPTER XVIII. 



JEruptitie Biseases, 



VARIOUS kinds of eruptions appear upon the skin of 
children, some of which are quite difficult to cure; while 
others, though of short duration, give rise to pain and con- 
siderable inconvenience. 

Prickly heat is usually caused by keeping the child so 
warmly clad as to produce excessive perspiration. The 
eruption consists of minute vesicles, the size of a pin-head, 
filled with clear water and situated mostly on the breast and 
other parts of the body. 

In the treatment of this disease attention must be paid to 
the clothing, which should be sufficient to protect the child 
from cold, but not so warm as to cause excessive sweating. 
The affected parts should be sponged with a mixture of vin- 
egar and water, after which they can be dusted with a pow- 
der consisting of oxide of zinc and starch in equal por- 
tions. 

Itch is a contagious disease, and children take it not only 
from nurses and other persons with whom they come in con- 
tact, but also from cats and other domestic animals. The 
eruption is usually seated on the inside of the thighs, the 
wrists, hands and feet, and between the fingers and toes. It 
is caused by a parasite which deposits its eggs under the 
skin, where they hatch out, leaving the insect to burrow into 
the tissues. 



260 The Mother's Hand-Book. 

The indications for treatment are: first, to destroy the in- 
sect and the eggs; and, second, to remove the symptoms pro- 
duced by scratching the skin. 

The child must first be washed with soap and water, after 
which it should remain in a hot-water bath for several min- 
utes. The whole body, except the head, should then be 
rubbed with sulphur ointment, made by thoroughly mixing 
one tablespoonful of powdered sulphur with four tablespoon- 
fuls of fresh lard. One application of the ointment, if thor- 
oughly made, is usually sufficient to destroy the parasite; 
but, if necessary, another can be made as soon as it has 
been ascertained that the first is ineffective. 

If there is much irritation of the skin left after the para- 
site has been destroyed, the oxide of zinc ointment, with a 
little powdered camphor added, will usually allay it in a 
short time. 

The child's clothing must be thoroughly disinfected. Such 
articles as cannot be boiled and washed must be subjected 
to a high degree of heat by passing A^ery hot irons over all 
parts of them. If this precaution be neglected the disease 
may last for an indefinite period. 

Nettle rash consists of rounded or oval elevations, or 
wheals, which are red at the margin and pale in the centre. 
The eruption is characterized by itching, burning or sting- 
ing sensations, which may be so severe as to give the patient 
no rest, causing him to rub the parts, with no other effect 
than to add to his suffering. The eruption is most common 
on the chest and back, though other parts of the body may 
be affected. 

The disease may disappear in a few days, or it may last 
for a long time. Some persons seem to be peculiarly liable 
to suffer from it. 

Treatment.— As nettle rash seems, in some cases, to be 
caused by disorder of the digestive organs, it is important 



Eruptive Diseases. 261 

in its treatment to pay strict attention to the diet, avoiding 
all indigestible or stimulating food. If the patient has, just 
before his attack, partaken of a full meal of rich food which 
has not been digested, it may be well to give him a mild 
emetic, such as powdered ipecac, for the purpose of getting 
rid of the contents of the stomach. 

In nearly all cases a simple laxative, such as syrup of rhu- 
barb or castor oil, will be beneficial. 

To remove the intense itching, various remedies have been 
tried. Sponging with vinegar and water is useful. Relief 
is often obtained by bathing with a mixture consisting of a 
heaping tablespoonful of baking soda dissolved in a pint of 
water. This should be applied quite warm to the skin with 
a sponge. Sometimes the oxide of zinc ointment rubbed 
upon the affected parts gives considerable comfort. 

Dandruff, or scurf on the head, is sometimes quite trou- 
blesome in young children. Little white scales form on the 
scalp in great abundance and produce considerable itching, 
and when they are removed another crop is speedily pro- 
duced. 

Treatment.— The head must be kept clean by washing it 
night and morning with warm rain-water, to which a little 
alcohol has been added. Warm vinegar may then be ap- 
plied, after which pure olive oil should be rubbed on the 
scalp. If this does not prove efficacious, an egg, well beaten, 
may be rubbed into the hair and afterwards washed out with 
warm water, when the oil should again be applied. If the 
head is combed, it must be done in the gentlest manner pos- 
sible, so as not to irritate the scalp. 

Red Gum. — This is an eruption occurring in young in- 
fants, usually before the sixth week, and is of trifling impor- 
tance. It consists of pimples of a bright red color, situated 
most commonly on the cheeks and forehead. It is usually 
connected with acidity of the stomach and a slight disturb- 



262 The Mother's Hand-Book. 

ance of the bowels. Nothing in the way of medicine is 
needed nnless it be small doses of carbonate of magnesia 
(lump magnesia) to correct the acidity of the stomach. 

RINGWORM HERPES CIRCINATUS. 

Ringworm may show itself on almost any part of the body; 
but the scalp is the seat of the most troublesome as well as 
the most common form of the disease. When thus situated 
it is known as scald-head. It commences in the form of 
minute, red, slightly elevated, round spots, which increase in 
size and become scaly. At first the eruption is limited to 
the surface of the scalp; but as it advances it becomes more 
deeply seated, involving the hairs, which become dry, twisted, 
and are easily extracted, and being very brittle, they break 
off just above the scalp. The affected surface may be round, 
but often it is irregular in shape. When the parts are highly 
inflamed, they are raised above the sound scalp, and have 
openings from which exudes a thick, honey-like discharge 
that masses the surrounding hairs together. In other cases 
pustules are formed, containing matter that dries into crusts, 
causing the disease to resemble milk crust. 

Treatment. — In treating ringworm of the head, all dress- 
ings, brushes, combs, etc., that come in contact with the 
sore should be destroyed. The effect of applying such arti- 
cles to the head a second time, while the sore is healing, 
would be to re-inoculate the parts and thereby delay the cure. 

Numerous remedies have been used in the treatment of 
scald head, but they all give so much pain, and require to be 
used with so much caution, that no mother should under- 
take the cure of a severe case, but should at once submit 
her child to competent medical treatment. Cleanliness of 
the parts must be enforced throughout the treatment, and 
frequent washings with rain water and carbolic soap will be 
necessary. 



Eruptive Diseases. 263 

When it is impossible to procure medical advice, the 
mother can, to a great degree, relieve the child, and possibly 
cure the disease by adopting the following plan: The hair 
being closely clipped so as to permit the medicines to come 
in contact with the diseased scalp, the sore should be washed 
with carbolic soap and warm rain-water. It may then be 
thoroughly wet with a wash made by dissolving twenty drops 
of carbolic acid in a tablespoonful of glycerine, to which 
three tablespoonfuls of alcohol and a half pint of water have 
been added. Ordinarily this wash should be permitted to 
dry on the surface; but if it produces too much burning a 
little warm water will soon remove it. 

The oxide of zinc mixed with glycerine to the consistency 
of a thick paste can then be applied. These applications 
can be made two or three times a day. 

If crusts form on the sore, the frequent use of an oint- 
ment composed of vaseline, to which a little calomel has 
been added, will be of great benefit. 

Ringworm appearing in small patches on different parts 
of the body can generally be cured by painting them with 
tincture of iodine. If the parts become raw after this appli- 
cation, they may be dressed with oxide of zinc ointment. 

SHINGLES HERPES ZOSTER. 

This disease consists of a vesicular eruption that appears 
upon the body — usually on the side of the waist, or the 
chest, or on the shoulder. Beginning near the spine, the 
eruption extends around the waist in an oblique direction. 
Sometimes the disease begins on one of the shoulders, 
whence it may extend in an oblique direction towards the 
breast. 

Occasionally the eruption is limited to patches of vesicles 
situated on the shoulder, the side, or front part of the chest. 
In rare cases both sides of the chest are affected, but when 



264 The Mother's Hand-Book. 

such is the case there will be an intervening space of healthy 
skin, as the disease never entirely encircles the body. 

The eruption appears at first as small, red spots, which 
soon assume the form of vesicles or blisters that are filled 
with a clear, watery fluid. These vesicles enlarge, and may 
reach the size of a pea, their contents gradually becoming 
thick and opaque. 

Sometimes the vesicles are joined together, forming blis- 
ters, varying in size and of irregular shape. As the disease 
declines, the vesicles dry up into thin crusts, which soon fall 
off, leaving the new skin beneath of a pinkish color. 

In mild cases there is but little, if any, fever, the erup- 
tion itself being the only manifestation of the disease. Oc- 
casionally, however, there is considerable fever, coupled 
often with sharp neuralgic pains in the affected parts. 

The eruption is attended with a burning and tingling sensa- 
tion that, in severe cases, may be sufficient to prevent sleep. 

Treatment. — The diet must be light, and partaken of in 
small quantities. If constipation exists it should be over- 
come by moderate doses of Epsom salts. 

The affected parts should be bathed with a solution of 
sugar of lead — a teaspoonful of the lead to a pint of water — 
and afterwards dusted with a powder composed of precipi- 
tated carbonate of zinc, to which one-twentieth of its weight 
of powdered camphor has been added. The camphor can 
be reduced to a fine powder before mixing it with the zinc 
by pouring over it a few drops of alcohol, after which it can 
easily be pulverized. 

If the parts become raw and inflamed it will be best to 
dress them with the oxide of zinc ointment. 

The affected parts should be protected from the rubbing 
of coarse or irritating clothing, and for this purpose a piece 
of soft canton-flannel can be sewed to the inner surface of 
the undergarment. 



Eruptive Diseases. 265 

fever-blisters herpes labialis. 

This is a somewhat painful and troublesome affection. 
Occasionally the eruption extends around the whole mouth ; 
but usually it is confined to one of the lips at or near the 
angles of the mouth. Patches of the eruption are often 
situated on the skin, either above or below the lips, and near 
the entrance to the nostrils. 

The vesicles are small, and at first contain a clear, watery 
fluid, which soon becomes turbid, changing to matter in 
three or four days. 

Kupture of the vesicles is followed by the formation of 
crusts, which soon fall off, leaving the surface below red, 
harsh and painful. 

Fever -blisters are often the sequence of febrile attacks of 
a mild character. Severe colds, when attended with fever, 
are not infrequently followed by fever-blisters. 

Treatment. — In most cases the application of dilute alco- 
hol — two parts of water to one of alcohol — four or five times 
a day will be found beneficial, both in relieving the burning 
sensation and curing the eruption. After each application 
of the alcohol, the parts should be anointed with vaseline, 
to which a small portion of camphor has been added. 

Occasionally the disease proves quite stubborn, yielding 
but slowly to the influence of medicines. In such cases, in 
addition to the use of the above remedies, it may be neces- 
sary to apply once a day a wash composed of from twenty 
to thirty drops of muriatic acid and two tablespoonfuis of 
water. The wash should contain enough of the acid to pro- 
duce a slight stinging sensation. Each time the acid wash 
is used it should be followed by the camphorated vaseline. 

ECZEMA. 

Eczema, in some of its forms, is the most common of all 
skin diseases, and maybe divided into two varieties: the 



2G6 The Mother's Hand-Book. 

simple and the red. The disease may be either acute or 
chronic, the chronic being the form usually met with in 
children. 

Simple eczema usually attacks the hands and arms, and is 
not attended with much fever or other constitutional symp- 
toms. At first, small vesicles, not larger than the head of a 
pin, containing a clear fluid, are seen on the skin. In the 
course of forty-eight hours the fluid in the vesicles becomes 
cloudy, and in three or four days it dries up, leaving a fine 
mealy exfoliation of the skin. This process may be repeated 
several times, causing the disease to last for many weeks ; 
when', instead of the ordinary exfoliation, the skin will be 
the seat of crusts or scabs, from between and under which a 
watery discharge will flow. The itching is troublesome, and 
if the parts be scratched, or greatly irritated, the disease 
may become chronic or else assume the form of red ec- 
zema. 

Red Eczema. — This is an inflammatory disease, generally 
commencing with a distinct fever, and attended with pain, 
heat and swelling. At first, numerous clear small vesicles 
are developed in an irregular manner in patches over a 
highly inflamed surface of a bright red color. The vesicles 
soon become cloudy, enlarge, and, bursting, form yellow 
crusts. In rare cases the disease may terminate in two or 
three weeks, the crusts falling off and the skin exfoliating. 
But usually a thin serous fluid continues to exude from the 
inflamed surface, and this discharge flowing over other por- 
tions of the skin spreads the inflammation. Bright red 
cracks and fissures form in the integuments", which are 
swollen and attended with pain and itching. Blood flows 
from the parts when scratched. If the discharge is scanty 
it soon dries, forming scales, which can easily be detached, 
to be followed by others. The disease, after being fully 
established, is very intractable and difficult to cure. Some 



Eruptive Diseases. • 267 

cases recover in a few weeks or months, while others may last 
for years. 

In chronic eczema, the disease loses its vesicular character; 
the swollen integuments thicken, and are elevated above the 
surrounding unaffected skin. The diseased surface assumes 
a dark hue, with numerous deep fissures that pour out a 
bloody discharge. The itching continues severe, and if the 
parts be rubbed, or otherwise irritated, they become inflamed. 

After awhile the child's general health is affected; the di- 
gestive organs are deranged, and the patient suffers from 
general debility. 

The most important and most frequent forms of this dis- 
ease, as it appears in children, is eczema of the face and 
eczema of the head. 

Eczema of the face usually begins on the forehead or cheeks, 
and may be limited to those localities, or it may spread to 
the surrounding parts, as the chin, ears and neck. When 
the disease is mild, the eruption leaves delicate scales or thin 
crusts after the vesicles break. In severe cases the crusts 
are thicker, more numerous, and when detached from the 
surface, leave the skin beneath red, inflamed and swollen. 
The parts are wet with a sero-purulent discharge, sometimes 
mixed with blood, that oozes from the inflamed surface. 
The eruption is attended with some itching and smarting, 
causing the child to tear the affected surface with its nails. 
In the very severe cases the discharge produces a thick 
discolored scab, covering the face like a mask. 

Eczema capitis, or milk crust, is often met with in infants at 
the breast when cutting teeth, and at later periods of child- 
hood in those that are scrofulous or poorly fed. It may be 
confined to a small part of the scalp, or it may cover the 
head and extend to the face and neck. 

This form of the disease presents a diversity of appear- 
ance in its different stages. The eruption is preceded by 



268 The Mother's Hand-Booe:. 

tingling and itching, followed by the appearance of small 
vesicles, crowded together in patches, or scattered over 
a large surface. When the vesicles rupture, their wa- 
tery contents run out on the scalp, matting the hair to- 
gether. In the acute form, the effusion is poured out for a 
long time; but in chronic eczema it soon dries, forming 
scales, which are pushed out by the hair as it grows. The 
vesicles, as a rule, appear first behind the ear, close to the 
edge of the hair, whence the disease spreads rapidly, usually 
attacking the ear itself. In some cases the entire scalp is 
covered with the eruption in a week or two, while in others 
it spreads very slowly. 

Although the hair may fall off in eczema from the violence 
of the disease, yet in all cases it will re-appear during the 
progress of cure. 

Eczema rubrum, when in its chronic stage, and situated 
upon . the t extremities, is generally called " salt rheum." 
When the disease is located upon the palms of the hands, 
or upon the soles of the feet, it constitutes, perhaps, the 
most intractable form of the malady. Indeed, severe cases 
of eczema in these localities are next to incurable. In wo- 
men who are compelled to do housework, the frequent placing 
of the hands in warm water seems to aggravate the disease 
and renders remedies almost useless. 

When the soles of the feet are affected, the disease is ag- 
gravated by the friction of the shoes and stockings, as well 
as by the perspiration produced by walking. 

In the treatment of eczema the greatest cleanliness must 
be observed, and the dressings and clothing should be fre- 
quently changed. As long as rags and similar articles are 
allowed to come in contact with the diseased surface after 
they have once been soiled, so long will the disease continue. 
The clothing must be changed every day, and clean articles 
substituted for the soiled ones, if a cure is to be hoped for. 



Eruptive "Diseases. 269 

If the child is troubled with diarrhoea, the probabilities 
are that the milk or other food does not agree with it, and a 
change of diet may be needed. If the bowels are consti- 
pated, they should occasionally be moved with syrup of rhu- 
barb or some other mild purgative. 

If the child is scrofulous, or if it is poorly nourished and 
emaciated, it may be benefited by giving it cod-liver oil in 
such doses as its stomach will bear. In short, efforts should be 
made by suitable nourishment to improve its general health. 

In most cases it will not be necessary to resort to medi- 
cines internally in treating eczema in children; but occa- 
sionally Fowler's solution of arsenic may be required to 
complete a cure. This drug, however, should be prescribed 
by a physician only. 

The treatment of eczema in its various forms by external 
applications is modified according to the stages and charac- 
ter of the disease. Thus, in acute forms, where there is 
heat, swelling and inflammation, the application should be 
mild and soothing. A wash consisting of an even teaspoon- 
ful of sugar of lead to a pint of warm water will serve a 
useful purpose. Soft, well-worn cotton or linen, wet with 
the wash, can be kept constantly applied. 

Sometimes moisture seems to aggravate the disease, and 
when such is the case, an ointment made of a teaspoonful 
of finely-powdered oxide of zinc and two tablespoonfuls of 
cold cream or vaseline may be used in place of the wash. 
If the itching is very severe, it is well to add five or six 
drops of muriatic acid to the ointment. 

If the affected parts are greatly inflamed they should be 
poulticed each night, and the ointment used during the day, 
until the inflammation subsides. A poultice made of ground 
slippery-elm bark or flaxseed meal will be best for this pur- 
pose. It should be applied warm and kept moist; otherwise 
it will stick to the parts and irritate them. 



270 The Mother's Hand-Book. 

When the disease becomes chronic, stronger applications 
are required. In such cases the itching is best relieved by 
wetting the affected parts with a mixture consisting of a tea- 
spoonful of muriatic acid and half a pint of water. Some 
of this can be applied to the rawest spot, and if it produces 
pain, causing the child to cry, a little water can be dropped 
on the part to relieve the burning, after which the mixture 
should be weakened by adding more water to it. If the child 
does not flinch when the wash is applied to the sore, a few 
more drops of the acid can be added to increase the strength 
of the mixture, which should be just sufficient to cause a 
very slight smarting sensation. This wash can be used at 
night, and the sore afterwards dressed with the oxide of zinc 
ointment. 

When the crusts are so thick and hard as to interfere with 
the application of the wash and ointment to the diseased 
surface, it will be necessary to use a wet poultice on the scalp 
to soften the scabs and promote their removal, even if there 
is but little inflammation present. 

The next morning the affected surface should be dressed 
with an ointment made by rubbing together an even tea- 
spoonful of white precipitate and three heaping tablespoon- 
fuls of fresh lard or vaseline. This ointment may be allowed 
to remain on the parts until mid-day, when it should be re- 
moved and the oxide of zinc ointment used in its place. 
This can be followed at night with the water and muriatic 
acid mixture. As the disease yields, the parts will com- 
mence to heal from the edges, thus lessening the size of the 
sore, when the remedies can be reduced in strength with 
benefit to the patient. While it is necessary to make two or 
three applications of these remedies of considerable strength, 
yet, after they have been so used a few times, it will be bet- 
ter to weaken them; otherwise the inflammation may increase 
and spread over more surface. 



Eruptive Diseases. 271 

In some chronic cases of eczema of the limbs, in old peo- 
ple, I have found the white lead paint, used after the man- 
ner directed in the treatment of burns, to speedily cure the 
disease after other remedies had failed. 

Eczema, especially of the scalp, is prone to recur after 
seeming recovery. Therefore, the nurse should be on the 
watch to detect the least re-appearance of the disease. At 
first a small spot or two of the eruption may be detected. 
The disease, if let alone, will spread rapidly, and, in some 
cases, within a week will become as extensive as it was at 
any time during the previous attack. 

The muriatic acid wash and the white precipitate ointment, 
as well as the oxide of zinc, should be kept constantly at 
hand, and when the disease begins to re-appear it should be 
attacked without delay. If used promptly, and according to 
the directions above given, these remedies will put an end 
to the trouble in a short time. 

SCARLET RASH. 

Scarlet rash is characterized by a superficial redness of the 
skin, appearing, in some cases, in large patches; in others, 
covering nearly the entire body. Usually it is attended with 
fever of a mild grade, which lasts but a few hours. The dis- 
ease may be caused by the irritation that accompanies teeth- 
ing, or it may be due to a disordered condition of the stom- 
ach and bowels, the result of over-feeding, or- of giving food 
of an improper character. 

Sometimes a child, while cutting its teeth, takes a cold that 
produces fever and disturbance of the digestive organs, fol- 
lowed by the peculiar eruption of scarlet rash. In such cases 
the rash will usually be of a bright red color, most promi- 
nent on the breast, and when pressed upon by the finger 
will disappear for a moment only, re-appearing almost as 
soon as the pressure is removed, 



272 The Mother's Hand-Book. 

Scarlet rash is a very mild disease, and is not attended 
with danger to life. The point of greatest interest in this 
affection is to distinguish it from scarlet fever. In some 
cases the eruption of the two diseases looks almost precisely 
alike, and to distinguish one from the other more attention 
should be paid to symptoms than to the rash itself. 

In scarlet fever we can generally ascertain that the child 
has been exposed to the disease — -at least, we can learn that 
there are other cases in the neighborhood, except in the very 
beginning of an epidemic. Scarlet rash usually appears 
when there are no other cases near, having a similar erup- 
tion. In scarlet fever, the throat symptoms are usually well 
marked, and patches of a white deposit can be seen on the 
tonsils. This is not the case in scarlet rash. It is true that 
in the latter disease we often find the throat red and some- 
what inflamed, but containing no deposit. In the course 
of a day or two all doubt as to the character of the disease 
will be removed, for the reason that if it is scarlet rash, the 
eruption will subside by that time, while in scarlet fever it 
continues for a much longer period. 

Treatment. — The disease requires but little treatment. If 
the bowels are not loose, a mild purgative should be given 
at the start, and a few drops of the sweet spirits of nitre in 
a teaspoonful of water can occasionally be administered to 
moderate the fever. The diet must be restricted in quan- 
tity until the fever subsides, and thirst should be allayed 
by small and frequent drinks of cold water. If the child 
suffers from itching of the skin, it should be carefully 
sponged with a mixture of warm water and vinegar. Pains 
must be taken to prevent draughts of cold air from passing 
over the patient, not only while the eruption is present, but 
also for a few days after it has disappeared. 



CHAPTER XIX. 



^xnte Contagion* 5*t$£ia$*s< 



MUMPS PAROTIDITIS . 

THIS is a contagious disease, occurring, as a rule, but once 
in the same person, and consists of a specific inflamma- 
tion of one or both parotid glands 

The disease usually makes its appearance about nine or 
ten days after exposure to the contagion, but in some cases 
the attack begins within five days, while in others twenty 
days may elapse before the disease manifests itself. 

Occasionally the disease begins suddenly, without any 
symptoms denoting its approach. Usually, however, there 
is slight chilliness and fever, attended with a feeling of de- 
bility, lasting a day or so, before any swelling of the jaws is 
noticed. 

The pain in mumps is felt at the angle of the jaw and 
darts into the throat and ear. The jaw becomes stiff; a 
swelling begins under the ear and extends upwards and for- 
wards. If the glands on both sides be affected at the same 
time, the face will have an enormously broad appearance. 
Ordinarily the swelling continues to increase for three to 
six days, when it begins to decline, and disappears in the 
course of ten or twelve days from its commencement. 

While the swelling continues the jaws are stiff, rendering 
chewing and swallowing painful. Talking also becomes 
difficult, and the voice is muffled and indistinct. Saliva of 
18 [ 273] 



274 The Mother's Hand-Book. 

a tenacious, stringy nature forms in the mouth, causing the 
patient great annoyance in getting rid of it. 

Often only one side is affected at first, but usually the 
disease extends in a short time to the other also 

In some cases, when a patient has been unduly exposed 
to the influence of cold, or has been taking too much exer- 
cise, a metastasis takes place; the privates in males and the 
breasts in females becoming inflamed and swollen. 

Treatment. — Mumps, although usually a mild disease, is 
attended with considerable pain and fever. If the pain in 
the jaws or ears is severe, hot poultices, or flannel cloths 
wrung out of hot water, applied to the affected parts, will 
often give considerable relief. 

The bowels should be kept open by means of Epsom salts 
or castor oil; and when there is much fever, a few drops 
of sweet spirits of nitre in water may be given. If the pri- 
vates become swollen and painful they should be suspended 
in a properly-constructed bandage, and warm applications 
applied to them. Pain and swelling of the breasts in females 
can be relieved by poultices or other warm applications. 

WHOOPING-COUGH. 

This is usually a disease of childhood, of a spasmodic 
nature, and rarely occurs oftener than once in a lifetime. 

Ordinarily, in about a week after exposure to the conta- 
gion, the disease begins as a common cold; but as it ad- 
vances the symptoms denoting whooping-cough become 
plainly marked. The symptoms of a common cold usually 
abate in a short time, but in this disease the cough, which 
often has a ringing sound, continues to grow louder, while 
the paroxysms last longer and are of a suffocative character. 
The child turns red in the face, and the whole frame is shaken 
with the cough, which becomes worse as the night approaches. 
Each fit of coughing begins with a full and prolonged inspi- 



Acute Contagious Diseases. 275 

ration, followed by a series of short, hurried expirations, 
succeeding each other with such rapidity and force as to al- 
most completely empty the lungs of air, and inducing a 
condition of seemingly impending suffocation. The child 
then takes a long, deep inspiration, attended with a peculiar 
sound — the "whoop" — from which the disease derives its 
name. 

In some cases, especially in young infants, the " whoop " 
is absent throughout the whole course of the disease. 

Bleeding from the nose sometimes occurs during the par- 
oxysms of coughing. These paroxysms may be frequent or 
infrequent; but usually after a quantity of mucus has been 
expelled by coughing or vomiting, the child will breathe 
more easily. A child that is old enough to run about the 
room usually knows when a fit of coughing is approaching, 
and if playing, will throw down its playthings and seize 
hold of a chair or some other support. 

In uncomplicated cases the general health may not be 
much affected between the paroxysms. The appetite re- 
mains good, the child is cheerful, and it sleeps well, except 
when disturbed by the cough. 

The disease gradually increases in intensity for about a 
week after the whoop is heard; the spells of coughing are 
more frequent and prolonged; the paroxysms of suffocation 
are more severe, and the whoop is heard oftencr. After the 
disease has remained stationary for about two weeks the 
symptoms begin gradually to decline. But for some time after 
the whoop ceases and the severe paroxj^sms of coughing have 
disappeared, exposure to cold will cause them to return. This 
is especially true during the winter season, and an attack 
beginning in early winter will usually affect the child to 
some extent until the warm weather of the following spring. 

In some cases of whooping-cough the symptoms are very 
severe in the beginning, and consist of a high grade o( fever, 



276 The Mother's Hand-Book. 

difficult breathing, and other indications of bronchitis. Not 
until these acute symptoms have subsided will it be possible 
to ascertain the real character of the disease. After the 
child has improved, so far as the acute symptoms are con- 
cerned, the cough continues, coming on in spells or par- 
oxysms, and after its continuance for some time the peculiar 
whoop is heard. This settles the true nature of the disease. 

Whooping-cough, of itself, is not often dangerous to life; 
but owing to certain complications that are liable to occur 
during the progress of the disease, each case becomes a 
source of some anxiety to the mother. Of these complica- 
tions, bronchitis and pneumonia are the most common, while 
convulsions and congestion of the brain may be present in 
rare cases. 

When bronchitis or pneumonia intervenes during an at- 
tack of whooping-cough, the symptoms are increased in 
intensity, the skin becomes hot, the pulse is fast, the breath- 
ing is frequent, the whoop is more violent, the cough more 
frequent and severe, being somewhat dry, and the little ex- 
pectoration that takes place consists of mucus nearly always 
streaked with blood. 

Bronchitis or pneumonia occurring in the early part of an 
attack of whooping-cough is quite dangerous, and children 
so affected may die within a week from the beginning of the 
complication. 

Convulsions and congestion of the brain may take place 
during the progress of whooping-cough and terminate in 
death. In rare cases a child may suddenly be seized with 
convulsions while in a fit of coughing, and death may happen 
in a moment from suffocation, caused by spasmodic closure 
of the windpipe. Oftener, however, drowsiness and other 
symptoms of brain trouble — especially vomiting not con- 
nected with paroxysms of coughing, nor due to the reme- 
dies given— will precede the convulsions. 



Acute Contagious Diseases. 277 

Diarrhoea not infrequently accompanies whooping-cough, 
but is usually not a fatal complication, unless it continues in 
the advanced stages of the disease, when it may destroy life 
by depressing the vital powers, thus leading to fatal exhaus- 
tion. 

The duration of whooping-cough is variable, and depends 
greatly upon the season of the year when the child becomes 
affected. Probably ten weeks may be named as the average 
duration of the disease. It often happens, however, that a 
child attacked during the early part of the winter will not 
be free of the cough until the succeeding warm weather. 
Then, again, cases beginning in the early spring will seem- 
ingly recover on the approach of warm weather, only to 
suffer a return of some of the symptoms when the cold 
weather of the following fall begins. 

Whooping-cough being contagious, it is important to know 
how long a time must elapse after the disease is developed, 
before it loses its contagious character. No definite answer 
can be given to this question. The safest rule is not to 
allow the affected child to mingle with others who have not 
had the disease, until the paroxysmal cough has entirely 
ceased. 

Treatment. — In the treatment of simple whooping-cough, 
hygienic means are of great importance. During the first 
few days, when the child has symptoms of a severe cold 
with fever, it should be confined to a room that is moderately 
warm. The sleeping apartment should be of nearly the same 
temperature as the one occupied during the day. Proper 
ventilation is necessary, but in winter very cold air should 
not be admitted. When the acute symptoms subside, the 
child may be allowed to exercise freely in the open air 
after clothing it sufficiently to keep it from becoming 
chilled. The diet must be mild and nourishing — milk form- 
ing one of the principal articles of food. Soups and broths 



278 The Mother's Hand-Book. 

in moderate quantities may also be given. Coarse articles 
of food, difficult of digestion, should be avoided. 

The chest can be well rubbed two or three times a day with 
a liniment composed of oil of cinnamon, one part; spirits of 
ammonia, two parts, and sweet oil, five parts. 

If the bowels are constipated, a dose of the syrup of rhu- 
barb or castor oil may be given, and, if required, it can occa- 
sionally be repeated during the progress of the disease. If 
there is much fever and heat of the skin, a few drops of 
sweet spirits of nitre, mixed with water, may be adminis- 
tered every few hours during the day, and once or twice 
during the night. If there is much wheezing with evidence 
of mucus in the air-tubes, the syrup of ipecac can be given 
in small doses to produce slight nausea, and if the breath- 
ing is difficult the syrup may be increased in quantities 
sufficient to cause vomiting. 

In cases where the cough becomes frequent and distressing 
as night approaches, two or three grains of bromide of potash 
ill a teaspoonful of water, to which eight or ten drops of God- 
frey's Cordial have been added, given to a child a year old, 
will usually secure needed rest for the night. 

To relieve the spasmodic cough and the difficult breathing 
that attends it, there are perhaps but few remedies equal to 
the hydrate of chloral. The usual dose is one grain for each 
year of the child's age, to be given in sweetened water. 
This remedy should be used with great caution, and unless 
the symptoms are urgent, and no physician can be consulted, 
it had better be omitted by the mother. 

In the latter stage of the disease, when the secretion of 
mucus is excessive, alum in doses of from two to five grains, 
according to the age of the child, will be most useful. It 
can be administered in a little honey or thick syrup. As 
the disease progresses and the child becomes weak and ema- 
ciated^ the diet must be increased, and nourishing food 



Acute Contagious Diseases. 279 

« 

should be given. In the latter stage of severe cases tonics 
will be required. The elixir of bark and iron, to be had at 
any drug store, will be found a useful tonic. A child one 
year old can take eight or ten drops three or four times a day. 
Whooping-cough, when complicated with bronchitis or 
pneumonia, is dangerous to life, and such cases should be 
promptly placed in charge of a physician. Also, when a 
case is complicated with convulsions, or congestion of the 
brain, no one but a physician should assume the responsi- 
bility of its management. 

DIPHTHERIA. 

This is an acute contagious disease, attended with fever, 
sore throat, enlargement of the glands of the neck, and, in 
some cases, is followed by paralysis of the muscles of the 
throat, eyes or extremities. It sometimes prevails as an 
epidemic, and seems to bear a close relationship to scarlet 
fever — cases of the latter disease, without the characteristic 
rash, having been mistaken for diphtheria. 

That diphtheria is contagious cannot be doubted, and 
when it appears in a family all the children may contract 
the disease unless they are separated from the sick. One 
attack does not secure immunity from subsequent ones. 

The poison of this disease exists in the exudations and 
secretions of the throat and nose; hence the nurse should 
exercise the greatest care, in making applications to those 
parts, not to receive the poison, either by inhaling it with 
the patient's breath, or by permitting the matter to enter 
her mouth or eyes from his efforts at coughing. 

The time when the disease may be expected to appear 
after exposure to the poison is uncertain. It may develop 
in two days, or not until eight or ten days have elapsed. 
Perhaps in a majority of cases the symptoms of diphtheria 
will be noticed within three days after exposure. 



280 The Mother's Hand-Book. 

Diphtheria may appear in one of three forms — viz., the 
catarrhal, the croupous, and the septic, or gangrenous. 

In the mildest, or catarrhal form, the patient at first suf- 
fers from heat, irritation, and pain in the throat, and swal- 
lowing is difficult and painful. There is chilliness, followed 
by fever, headache and pains in the muscles. The fever may 
be either mild or severe, and attended with nausea and vom- 
iting. The tongue is covered with a white fur, and on in- 
specting the throat the lining membrane will be found un- 
usually red, while small grayish-white patches will be seen 
situated, as a rule, on the tonsils at the sides of the throat. 
In some cases this deposit is found almost at the commence- 
ment of the disease, but usually it is a day or two before it 
appears. It may be confined at first to the tonsils, but soon 
extends to the back of the throat and to the posterior mar- 
gin of the roof of the mouth. Usually this deposit or mem- 
brane has a grayish-white appearance; but in severe cases 
it may be of a dark-red color, owing to an exudation of 
blood. 

In the mild form of the disease the membrane may be 
confined to small specks or flakes, which usually assume 
a slightly yellowish color on the second or third day, when 
they seem to lose their vitality, and gradually disappear 
under proper treatment. 

The croupous form of the disease may begin as a mild at- 
tack; but instead of convalescence beginning on the fourth 
or fifth day, the child grows worse; the fever increases; the 
glands of the neck swell and become painful, while the false 
membrane spreads over a greater portion of the throat. The 
deposit often forms inside of the nostrils, preventing the pa- 
tient from getting his breath through the nose. Blood, mu- 
cus and pus flow out of the nose and upon the lips, excoriat- 
ing them and adding greatly to the patient's distress. The 
membrane in these cases may extend into the windpipe, giv- 



Acute Contagious Diseases. 281 

ing rise to all the symptoms of an aggravated case of croup, 
speedily ending in death. 

Cases of catarrhal, and especially of croupous, diphtheria 
may develop into the septic form. The blood becomes poi- 
soned by the absorption of decomposed exudations and se- 
cretions from the throat, nose, and other affected parts of the 
body. The glands of the neck are greatly swollen and pain- 
ful. The urine is scant and contains albumen, while diar- 
rhoea and vomiting are often present. This form of the dis- 
ease is usually fatal ; but recovery may sometimes take place. 

The gangrenous is only an extension of the septic form. 
The mucous membrane of the mouth, throat and nose be- 
comes gangrenous — -mortified — emitting a horrible odor, and 
death speedily ensues. 

Paralysis of different parts of the body may occur as the 
result of diphtheria, even in its mild form. When it hap- 
pens during the progress of the disease it, of course, adds 
to the severity of the symptoms, and diminishes the chances 
of recovery; but when it takes place a few weeks after ap- 
parent recovery, it may be considered as an independent 
disease. Paralysis may begin in the muscles of the mouth 
and throat, causing difficulty of swallowing, and giving a 
nasal tone to the voice; or the muscles of the eye may be- 
come affected, causing double vision or cross-eyes; or the 
muscles of the arms or legs may become paralyzed and waste 
away, producing, in some cases, permanent lameness. But, 
as a rule, paralysis following diphtheria is a curable affection. 

Diphtheria may be, and often is, confounded with follicu- 
lar tonsilitis, which is not a dangerous disease. It is because 
of this mistake that we hear of so many attacks of diphthe- 
ria occurring in the same child. In follicular sore throat, as 
in diphtheria, there is fever and sore throat, and even some 
swelling of the glands of the neck, but the appearance of the 
deposit is different. In the former disease it consists of small 



282 The Mother's Haxd-Book. 

specks of a grayish, cheesy secretion, deposited at the orifices 
of the follicles. Instead of standing out beyond the mucous 
membrane, as in diphtheria, these specks are depressed or 
sunken. As the disease progresses the deposit does not be- 
come augmented or enlarged to any great extent, while in 
diphtheria there is usually a gradual increase in the size of 
the deposit until the disease has reached its acme. Besides, 
the deposit in diphtheria is upon the mucous membrane, 
giving it somewhat the appearance of having been glued 
thereon. 

The appearance of the throat in diphtheria and in scarlet 
fever may be so much alike as to cause cases of the latter dis- 
ease, when the eruption is absent, to be mistaken for the 
former. 

When a case of diphtheria occurs in a family, the child 
should, if possible, be placed in a room to which others are 
not admitted. The disease being contagious, there is great 
danger that other children will take it if permitted to be 
near the sick one. The room must be well ventilated by 
carefully admitting air from other rooms. 

All cloths, handkerchiefs, and other materials used about 
the bed, which are contaminated with discharges from the 
patient's mouth, throat or nose, must be destroyed, either by 
burning or by burying them in the ground. Discharges 
from the patient's bowels must be promptly removed from 
the room and buried. After convalescence is established, 
the bed, furniture and room must be disinfected, and the 
bedclothes boiled and thoroughly washed. Xo child should 
be admitted to the room until all these directions have been 
carefully complied with. 

Treatment. — In the beginning of mild as we'll as severe 
cases, the mother should see that her child is kept in a well- 
ventilated room, and that it remains in bed most of the 
time. The diet should consist of such articles as are easily 



Acute Contagious Diseases. 283 

digested. Milk, beef-tea, and other liquid foods may be 
given. As the disease advances and the child becomes de- 
bilitated, the necessity of supporting the strength by feed- 
ing increases correspondingly. Under such circumstances 
stimulants, such as egg-nog, wine, etc., should be given, and 
every effort possible made to nourish the child. 

A teaspoonful of powdered chlorate of potash can be added 
to a pint of water, of which mixture the patient can take a 
tablespoonful every three or four hours. 

Locally, a gargle of very warm water should be used four 
or five times a day, each gargle to be followed by another 
made by dissolving a large teaspoonful of tannin in two 
tablespoonfuls of alcohol, to which should be added four 
tablespoonfuls of water. Of this mixture a tablespoonful 
can be used each time. If the child is too young to use 
the gargle, the mother may take a good-sized camel's- 
hair brush, and, dipping it into very warm water, wash the 
affected part of the throat, removing the mucus to some ex- 
tent; then dipping the brush in the alcohol and tannin mix- 
ture, she must make a thorough application to the diseased 
structures. In mild cases the diphtheritic deposit will soon 
lose its white appearance, become somewhat yellow, and in 
two or three days disappear. 

When the glands of the neck are swollen and painful, very 
warm sweet oil or fresh lard may frequently be applied to 
them, and gently rubbed into the skin with the hand. 

Unless the bowels are loose at the beginning of the attack, 
a small dose of castor oil or syrup of rhubarb should be 
given, so as to act gently, but without purging the child 
enough to weaken it. Should the child show signs of grow- 
ing worse, even in the mildest cases, and in every case where 
the disease is at all severe in the beginning, no lime should 
be lost in temporizing measures, but a physician must be 
summoned as soon as possible. 



284 The Mother's Hand-Book. 

Probably in no disease is it more important to guard the 
patient against taking cold than in diphtheria. During con- 
valescence from even an ordinary case, the mere going into a 
cold room and remaining there for a few minutes may be 
sufficient to cause a fatal attack of croup. 



CHAPTER XX. 



Petite Contagious J3ise&$£s< 

(Continued.) 



SCAELET FEVER, OR SCARLATINA. 

ATTACKS of scarlet fever are usually confined to the 
period of childhood. The disease rarely occurs more 
than once in the same patient. Epidemics differ greatly in 
their severity — some being very mild, while others are at- 
tended with a fatality rarely observed in any other disease. 

Epidemics of scarlet fever are rarer in small towns and 
country districts than in large cities; but they are usually 
of a more severe type in the former than in the latter local- 
ities. 

An attack of scarlet fever may be so mild as not to cause 
the child a single day's confinement to the bed; while, on 
the other hand, it may be so deadly as to destroy life in a 
few days, or even hours. The disease usually makes its ap- 
pearance in about seven days after exposure. Sometimes, 
however, twelve or fourteen days may elapse before the 
child shows any signs of being sick. 

Scarlet fever has been divided into three forms, corres- 
ponding to the severity of the attack. In the simple form 
the disease usually begins with vomiting, often repeated; 
with fever, as shown by the intensely hot skin, rapid pulse, 
great thirst and headache; with delirium to a greater or less 
degree. Usually within twenty-four hours from the com- 

(285) 



286 The Mother's Haxd-Book. 

niencenient of the attack, the peculiar rash makes its ap- 
pearance. Beginning on the neck and upper part of the 
chest, it extends during the next twenty-four hours to the 
body and the extremities. The color of the rash is bright 
red, caused partly by the blush of the skin and partly by 
the appearance of little spots or specks, which are distinct, 
though not elevated. Between these spots, at first, are small 
spaces of pale skin, which soon become reddened by the red 
spots coalescing. The skin around the mouth and chin is 
usually pale, being in striking contrast to the intense red- 
ness of the neck. The rash generally becomes deep in color 
and more diffused over the body during the first three days, 
after which it slowly declines, disappearing aoout the seventh 
or eighth day. 

The fever and acute symptoms usually continue, increas- 
ing in severity until the eruption has reached its height, 
when they gradually decline with the disappearance of the 
rash. In extremely mild cases the fever may subside when 
the rash is fully out. 

The soreness of the throat is a symptom usually present 
on the second day. Swallowing becomes painful, the ton- 
sils and back j>art of the throat are red and swollen, the 
tongue is covered with a whitish fur, through which project 
little elevations that are usually red and prominent, consti- 
tuting what is known as the " strawberry " tongue. 

As the, rash subsides the outer layer of the skin begins to 
peel off in scales, the largest coming off of the hands and 
feet. Sometimes the peeling-off process is not so distinctly 
marked, and consists in the skin's throwing off small thin 
scales. 

In the anginose form, the disease expends its force mostly 
upon the throat. The first symptoms are usually more 
severe than in the simple variety; the rash is longer in 
making its appearance, and sometimes, instead of being dif- 



Acute Contagious Diseases. 287 

fused over the whole body, it appears in large patches, espe- 
cially on the back. In this variety the rash may (though 
this is rare) be entirely absent, the disease showing itself 
only in the throat. Such cases may be mistaken for diph- 
theria — an error that will be recognized only when other 
children of the same family have scarlet fever with all the 
symptoms well marked. 

Soon after the beginning of an attack of the anginose 
form of scarlet fever, soreness of the throat, with difficulty 
of swallowing, and pain and stiffness of the neck, and 
swelling of the glands under the lower jaw, will be noticed. 
The throat, on examination, is found intensely red; the ton- 
sils red and swollen, the swelling rapidly increasing until it 
nearly closes the back part of the throat, thus rendering 
swallowing so difficult that fluids are often returned through 
the nose. A thick, sticky mucus collects about the back 
part of the throat, and patches of deposit, in appearance 
much like that seen in diphtheria, form on the tongue. In 
severe cases a thick, adhesive, yellowish matter adheres to the 
nostrils, obstructing the free passage of air, and adding to the 
difficulty of breathing. This yellowish secretion sometimes 
runs out of the nose upon the upper lip, producing excoria- 
tions and troublesome sores. 

In some cases the parotid glands and the tissues at the 
side of the neck become inflamed, swell rapidly to a great 
size, and feel hard to the touch. This may be confined to 
one side or it may affect both sides of the neck. The pa- 
tient is unable to open his jaws wide enough to take any 
but liquid nourishment; the voice is smothered, and speak- 
ing is painful. The tongue becomes dry, is covered with a 
brown fur, and is red at the tip and edges* 

Malignant scarlet fever may be considered as an aggravated 
form of the anginose variety. Some patients, however, die 
before the throat symptoms are developed. Death may oe- 



288 The Mother's Hand-Book. 

cur within forty-eight hours from the beginning of the at- 
tack. In such cases the child may have convulsions at the 
start, followed by coma and death; or the attack may be 
ushered in by symptoms of profound shock, from which the 
patient rallies only to sink from its effects in a day or two. 
In other cases an uncontrollable diarrhoea sets in and speed- 
ily destroys the patient. 

But death does not always take place so soon; the patient 
may live for a week or two, dying, finally, from the absorp- 
tion of poisonous secretions from the nose or other parts, or 
from the destructive ravages of the disease in the throat. 
Sloughs may occur in the back part of the throat and in the 
tonsils, leaving deep, ragged and unhealthy ulcers. The 
swelling of the parotid glands increases, and by extending 
to other tissues near by, forms a sort of collar of great hard- 
ness around the front and sides of the neck, which interferes 
with both breathing and swallowing. These swellings rarely 
suppurate, but occasionally large quantities of matter form 
in them, destroying the cellular and other tissues of the 
part. After the matter has been evacuated, the muscles and 
blood-vessels of the neck may be seen; the tissues between 
them having been destroyed by the ulcerative process. 

Sometimes the various joints of the body are affected 
during the progress of scarlet fever, due, most likely, to the 
absorption of poisonous material from the throat and neck. 

Inflammation and suppuration of the ear often follow 
scarlet fever. In some cases the hearing is permanently 
destroyed or greatly impaired, and in others, although the 
hearing is not affected to any great extent, the running of 
matter from the ear will continue for months or years, re- 
quiring careful attention to keep it clean by daily syringing 
with warm water. 

The kidneys often become affected during the course of 
scarlet fever, leading to dropsy after the acute symptoms 



Acute Contagious Diseases. 289 

have passed away. This is apt to occur after a mild attack, 
the reason being that in such cases children are permitted 
to go into the cold air too soon after the skin has peeled off. 
Nearly all cases of dropsy following scarlet fever are pro- 
duced by early exposure to cold; hence the child should be 
kept within doors for at least two weeks after seeming re- 
covery from even mild cases. 

When dropsy occurs after scarlet fever, the child will at 
first be languid and fretful, with a slight fever and hot skin. 
The appetite fails, and the bowels are usually constipated. 
In a little while a puffiness is noticed about the eye-lids, and 
the face is slightly swollen; the swelling soon extends to 
the hands and feet, and the abdomen becomes hard and 
tense. 

If properly treated, this form of dropsy usually disap- 
pears, and the child recovers its health. But occasionally 
the kidney affection present in these cases results in death, 
either from convulsions, from the supervention of pneumo- 
nia, from pleurisy, or from the abundant effusion that takes 
place in the chest. 

Treatment. — As soon as a child is known to have scarlet 
fever it must be separated from other children, and placed 
in a room of moderate temperature. The room must be- 
well ventilated, but no current of air should be permitted 
to pass over or near the patient. All secretions from the 
mouth, throat and nose must be removed and destroyed as 
soon as possible. The discharges from the bowels should 
be taken from the room and buried without delay. The 
diet must be mild and mostly of a liquid nature. Milk, 
beef and chicken broth, and, in mild cases, rice, oatmeal, 
tapioca, and other bland articles, can be allowed. In pro- 
tracted cases, when the strength begins to decline, the food 
should, if possible, be increased, and fresh milk, if it agrees 
with the child, can be given often and somewhat freely. 
19 



290 The Mother's Hand-Book. 

The throat should be kept as free as possible from the 
thick, tenacious mucus that collects upon its lining mem- 
brane. If the child is old enough, it can use the alco- 
hol, tannin and water gargle described in the article on 
diphtheria. If too young to use it in this manner, the 
nurse can apply it to the throat with a camel's-hair brush, 
as directed in the same article. In severe cases, where the 
throat is badly affected, much stronger applications must be 
made, but these should be used only by a physician. 

In this disease, as well as in diphtheria, the remedies must 
be applied to the throat carefully and quickly, so as not to 
irritate the parts enough to cause a paroxysm of coughing; 
otherwise some of the secretion from the child's throat may 
be expelled with such force as to find its way into the nurse's 
mouth or eyes. If such an accident should happen, the 
poisonous material must be gotten rid of by immediately 
and thoroughly bathing the mouth or eyes with warm 
water. 

If there is much swelling or pain in the neck, a warm 
poultice of flax-seed meal should be applied. If the fever 
is very high, sponging with warm water will be beneficial 
and soothing. This must be clone with care, the sponge 
being used while the child is lying on one blanket with an- 
other thrown over it. 

A teaspoonful of chlorate of potash may be added to a 
pint of pure water, and a dessertspoonful of this given to 
the child when it is thirsty. 

In the beginning of the disease a dose of rhubarb or mag- 
nesia may be given to move the bowels thoroughly, but it 
should not be repeated except upon the advice of a physi- 
cian. 

The treatment of severe cases of scarlet fever will not be 
given in this book, as no one but a skilled physician should 
undertake the management of such a fatal disease. 



Acute Contagious Diseases. 291 



MEASLES. 

Measles is a contagious disease, occurring, with rare ex- 
ceptions, but once in a lifetime. It is not only communi- 
cated by actual contact with the sick, but the contagion may 
be conveyed long distances through the medium of clothing 
and other articles. Susceptibility to the poison differs in 
different persons, and infants at the breast are rarely affected 
by it. The contagious principle is present from the begin- 
ning to the end of the disease, but it is most marked when 
the symptoms have reached their highest point. 

The eruption usually makes its appearance within four- 
teen days after exposure, and on the fourth day of the fever; 
but this rule has many exceptions, for the rash may appear 
on the second or third day of the fever, and in rare cases it 
may be delayed for a week longer. 

An attack of measles begins as a common cold. The pa- 
tient, after having been in good health, becomes restless, 
thirsty and feverish, and complains of headache. The eyes 
are red, weak and watery, and sensitive to light. Fits of 
sneezing occur quite often, and the patient is troubled 
with cough, which is at first short and dry, but afterwards 
changes in tone, so that on the third day, when the dis- 
ease has reached the larynx, it is harsh and resounding, 
soon becoming hoarse and husky. Further along in the 
course of the disease, the cough is looser and is followed by 
copious expectoration of mucus. Usually on the fourth day 
the rash makes its appearance, first on the face, whence it 
extends, in about forty-eight hours, over the rest of the body 
and extremities, traveling from above downwards. By care- 
ful examination, the eruption may often be seen in the roof 
of the mouth several hours before it appears on the skin. 

The eruption of measles is of a dark rod (sometimes of a 
rose) color, and somewhat resembles flea bites. The erup- 



292 The Mother's Hand-Book. 

tive spots are small, and, although close together, they are 
distinct, leaving the skin between them of a natural color. 
They are slightly elevated above the surrounding skin, espe- 
cially on the face. These spots are usually crescentic in 
shape, except where they become confluent, or join each 
other, which is apt to occur on the cheeks, when they con- 
stitute irregular blotches, a third to a half inch in length, 
by half of that size in breadth. The eruption fades in the 
same order in which it ajDpeared. Within forty-eight hours 
from its appearance on the face, it is at its height on the 
trunk. It now begins to fade from the face, continuing, 
gradually, from above downwards, until on the seventh day 
the rash grows faint on the body generally, and on the 
eighth or ninth day it has vanished, leaving behind a little 
redness of the surface, or a few yellowish red spots. 

In some cases, when the fever has been high and the rash 
profuse, there is, after the disappearance of the eruption, a 
slight exfoliation of the skin in the form of minute branny 
scales; but it is never so great as after scarlet fever. 

The fever in measles does not subside upon the appear- 
ance of the rash, but for a day or two after it increases in 
severity. Usually, however, by the sixth day it abates, and 
the cough becomes easier and less frequent. 

Cases of measles not complicated with other diseases usu- 
ally end in recovery, and require but little medical treat- 
ment. Complications may, however, arise during the course 
of measles, rendering an attack dangerous to life. Thus, in 
rare cases, convulsions may imperil the lives of young chil- 
dren before the rash is noticed. Usually, however, they 
cease after the eruption appears, the child finally making a 
good recovery. In other cases the rash, after having been 
well developed, prematurely disappears, and is followed by 
convulsions, which may terminate in death. 

Sometimes, though rarely, croup may supervene during 
the progress of measles. The hoarse cough and suppressed 



Acute Contagious Diseases. 203 

voice that are present in the early stages of measles often 
lead one to fear that an attack of croup is impending; but 
such a complication is more apt to occur when the eruption 
is on the decline, or has disappeared, than in the early stages 
of the disease. 

Owing to a retrocession of the rash, pneumonia or bron- 
chitis may arise during the course of measles. So, also, if 
a patient is unduly exposed to the influence of cold during 
the decline of measles, he may suffer from bronchitis or 
pneumonia, thus incurring disease of the lungs that is liable 
to terminate in consumption. 

Occasionally, when a child is attacked with measles while 
suffering from bronchitis or other lung trouble, the rash 
shows itself imperfectly, and is at first of a dark, livid hue, 
the breathing being labored and attended with great diffi- 
culty. This form of the disease has been called by some 
"black measles," and is caused by congestion of the lungs 
or other organs. 

Diarrhoea may be severe and persistent during the course 
of measles. Even a mere looseness of the bowels should 
receive attention; otherwise it may terminate in severe diar- 
rhoea, or perhaps dysentery. 

Treatment. — A simple, uncomplicated case of measles re- 
quires very little medical treatment; confinement to a warm, 
well-ventilated room, with a spare diet, constitutes the most 
important part of the management of such a case. Where 
the cough is troublesome, relief may be afforded by giving 
small doses of a mixture containing two parts of syrup of 
ipecac and one part each of sweet spirits of nitre and God- 
frey's Cordial. Of this mixture twenty drops can be given 
to a child one year old, and repeated every three or four 
hours if the symptoms be urgent. 

Sometimes when the eruption declines, the patient suffers 
from an intense itching of the whole surface. Relief is ob- 



294 The Mother's Hand-Book. 

tained by sponging the body with very warm water (the pa- 
tient lying under a blanket), and, if necessary, following 
the sponging by an application of vaseline to the skin. 

If the bowels are constipated they can be gently moved 
by a suitable dose of syrup of rhubarb or castor oil; but ex- 
cessive purging must be guarded against. The diet must 
be plain and nourishing. Kice, milk and similar articles 
can be given in such quantities as the patient may be able 
to digest. 

The treatment of a complicated case of measles should 
always be conducted by a qualified physician. In the ab- 
sence of such a person an intelligent mother can greatly 
assist nature in restoring the patient to health even in se- 
rious cases. 

If the lungs become involved, as shown by rapid and diffi- 
cult breathing — the child seeming to be in the greatest dis- 
tress — and if the eruption is not well out, the mother can 
place the patient in a hot bath for a few minutes. After 
taking it out of the bath it should be dried and wrapped in 
blankets. This will often cause the eruption to appear upon 
the skin and greatly relieve the oppressed breathing. If, 
however, the breathing continues difficult, a mustard plas- 
ter, mixed as heretofore directed, should be placed over the 
front part of the chest. 

If croup is threatened, the mother should push the admin- 
istration of the syrup of ipecac, giving larger doses than be- 
fore, and also apply hot flannel cloths to the throat. The 
cloths should be of several thicknesses in order to retain 
heat for a long time. 

Diarrhoea can be controlled by restricting the diet to rice, 
boiled milk, crackers, etc., and giving either Godfrey's Cor- 
dial or Dover's powder in suitable doses. 

Convulsions occurring either before the eruption has ap- 
peared upon the skin, or upon a retrocession of the rash 



Acute Contagious Diseases. 295 

after it has once shown itself upon the body, are best treated 
by placing the patient in a hot bath. The child should be 
kept in the hot water only a few minutes at a time, after 
which it should be enveloped in blankets. The bath may 
be repeated at suitable intervals until the convulsions cease 
or the eruption appears. Medicines to control convulsions 
should be given by a physician only. 

ROTHELN, OR GERMAN MEASLES. 

This is an eruptive fever, propagated by contagion, and 
attended with a rash resembling that of true measles. The 
rash begins on the first day of the illness and appears pri- 
marily on the face, extending within twenty-four hours to 
the body and limbs. The fever and eruption usually dis- 
appear on the third day. The sneezing, the red, watery eyes 
and other symptoms of catarrh that precede the eruption of 
measles, are not observed, to any great extent, in attacks of 
rotheln. 

About two weeks usually elapse between the time of expo- 
sure and the beginning of the disease. There are many ex- 
ceptions, however, to this rule. 

It is rare that a person suffers from this disease a second 
time; but an attack of German measles is no protection to 
one who is exposed to the contagion of true measles. 

Rotheln is often met with during the prevalence of an 
epidemic of measles, and a patient, after recovering from it, 
may suffer in two or three weeks from the latter disease. 
Infants at the breast are not as susceptible to the contagion 
of rotheln as children who have passed the period of weaning. 

This disease is contagious both before the rash appears 
and for several days after its subsidence; hence it is very 
difficult to prevent its spreading, even by isolating the sick. 

The first symptoms that are noticed after exposure are 
giddiness and pain in the head, aching in the back and 



296 The Mother's Hand-Book. 

limbs, and a little tenderness of the throat. These symptoms 
are usually present a day or two before the rash appears, but 
they may be so slight that no notice is taken of them, the 
rash itself being the first thing that calls attention to the dis- 
ease. While the glands of the neck may be slightly swollen 
and the throat red, there is an absence of the exudative de- 
posit upon the tonsils that is met with in scarlet fever. 

The eruption in rotheln consists of bright red rounded 
spots, with clear skin between them at first, though they 
soon become joined together. They are not grouped in 
patches as in measles, but more diffused like in scarlet fever. 
The eruption is more elevated and distinct in spots than in 
the latter disease, and besides it lacks the finely diffused 
bright redness on the neck and chest that is seen in scarlet 
fever. The rash fades from the face and upper part of the 
body while it is spreading to the limbs, and is, therefore, 
less intense on the third da} r . After recovery the skin does 
not peel off as in scarlatina. The fever is usually highest 
on the first day of the eruption and subsides on the third 
day. For a week after the rash fades there is a tendency to 
its recurrence with fever from slight causes. 

Rotheln is distinguished from true measles by its sudden 
appearance without the previous sneezing, red watery eyes, 
and cough, that precede the latter disease. The eruption, 
though greatly resembling measles, is not so crescentic in 
shape and is more evenly diffused over the body, nor is there 
such a gradual approach of fever before the rash appears. 

From scarlet fever it is distinguished bj r the absence of 
the peculiar deposit in the throat, the strawberry tongue, and 
the swelling at the angle of the jaw, that belong to the latter 
disease. Besides, the eruption on the first day consists of 
rounded spots, larger and more elevated than in scarlet fever, 
and it is not until the second day that the redness becomes 
diffused as in the latter disease. 



Acute Contagious Diseases. 297 

From scarlet rash it is to be distinguished by the eruption, 
which, in the latter malady, consists, at first, of minute 
points not raised above the skin surrounding them, which 
soon coalesce, forming a diffused red surface closely, if not 
completely, resembling the rash of scarlet fever. Scarlet 
rash lasts but a day or so, while the eruption of German 
measles continues for three days; and besides, scarlet rash, 
unlike the latter, is not a contagious disease, and does not 
occur in an epidemic form. 

But little treatment is required in German measles. Rest 
in bed for a few days and confinement to the house for a 
week is most that is necessary. Small doses of sweet spirits 
of nitre in water, when the fever is high, will be useful, and 
the patient may drink freely of lemonade. If the throat is 
painful, or if it is lined with tenacious mucus, a gargle of 
alcohol and water, to which a little chlorate of potash has 
been added, will be beneficial. 

Attention should be paid to the bowels, and if they are in- 
clined to constipation a mild dose of castor oil or syrup of 
rhubarb may be given. The diet should be confined to mild 
articles that are easily digested. 

VARICELLA, OR CHICKEN-POX. 

This disease may be propagated either by contagion or by 
epidemic influences. It occurs but once in the same indi- 
vidual, ahid is not dangerous to life. In some very mild 
cases there are no premonitory symptoms, the eruption itself 
being the first thing noticed. Usually, however, the child 
suffers from slight chilliness, followed by fever, headache, 
pain in the back, thirst, and loss of appetite. 

The eruption, as a rule, appears primarily on the back or 
chest, though in many cases it is first observed on the face, 
neck or abdomen. It consists of small, slightly elevated, 
rose-colored spots, varying in number from a dozen or two 
to several hundred. These spots, which are at first very 



298 The Mother's Hand-Book. 

small, in the course of twelve or twenty-four hours from 
their appearance contain a clear watery fluid. They soon 
enlarge, assume a somewhat round shape, have a glistening 
appearance, and in a short time their contents become 
opaque or cloudy. At the end of the second day the vesi- 
cles are completely developed, and on . the third day they 
present a somewhat pustular appearance. As a result of the 
child's rubbing the parts to relieve the troublesome itching, 
a few true pustules may develop. On the fourth day the 
vesicles begin to dry up, and by the sixth complete scabs 
form. The scabs fall off in a few days, leaving red spots, 
some of which may be pitted. A single crop of the erup- 
tion may be said to complete itself in five or six days, and 
as two or three crops appear on as many successive days, 
the illness will last a little more than a week. In rare cases 
there may be four or five crops of the eruption, causing the 
illness to continue for two weeks. 

This disease may be mistaken for varioloid. In the lat- 
ter, however, the initiatory fever is more severe, lasting 
three or four days instead of from twelve to thirty-six hours, 
as in chicken-pox. The eruption in varioloid begins on the 
face and extends very slowly to the body and extremities, 
wdiile in chicken-pox it usually begins on the back or breast 
and spreads rapidly. Within twelve to twenty-four hours 
after their appearance, the eruptive spots become vesicles 
filled with a clear fluid, which soon becomes cloudy or 
opaque, and on the third day some of them may contain 
matter. On the fourth day the vesicles begin to dry up, 
and by the sixth form complete scabs. 

The treatment of chicken-pox consists in confining the pa- 
tient to his room, and if there is much fever, to his bed, for 
one or two days, and giving him mild nourishing food. 

Constipation of the bowels should be corrected by a mild 
laxative, and, if necessary, the sweet spirits of nitre can be 
administered to moderate the fever. 



CHAPTER XXL 



Occidents mtft Injuries* 



BURNS AND SCALDS. 

BURNS and scalds differ from each other simply in this, 
that one is the result of dry and the other of moist 
heat. For practical purposes, they may be considered as 
identical. 

As a rule, a burn, while limited to a smaller surface, usu- 
ally affects deeper structures than a scald. However, cases 
often occur where, from the burning of a child's clothing, a 
large portion of the surface of the body is involved. 

Scalds produced by contact with hot water or steam are 
usually extensive in character. Occasionally — usually in 
adults — the throat and air-passages are affected from inhal- 
ing the vapor of escaping steam. 

Contrary to the usual belief of non-professional persons, 
the danger of a burn depends more upon the extent of sur- 
face involved than upon the depth of the injury. Thus, 
while a child may recover from a burn that has destroyed 
the structures to a considerable depth, but is of limited area, 
it is almost certain to die if one-third of the surface of its 
body is merely blistered. 

In cases of burns or scalds involving a large portion of the 
body, death is often caused by the shock. The patient feels 
exceedingly cold, or perhaps has violent rigors. ITis pulse 
is small, frequent and feeble; his respiration is oppressed, 

[299I 



300 The Mother's Hand-Book. 

and there is extreme restlessness, with great thirst and sick- 
ness at the stomach. If he lives over the primary effects of 
the shock, and reaction takes place, he will have violent fe- 
ver, a flushed countenance, and a quick, irritable pulse, with 
a tendency to delirium. If he dozes, it will he hut for a few 
moments at a time, during which he will talk incoherently. 

Usually the pain produced "by a burn is of a most intense 
character; but sometimes the shock is so great as to over- 
whelm the nervous system, in which case the patient will 
complain but little of suffering. If death is not produced 
by the shock or its results, it is liable to occur from certain 
complications that may arise in the course of a few days. 
Thus, if the neck or scalp be the part burned, inflammation 
of the membranes of the brain may follow; if the chest be 
involved, inflammation of the lungs may result; while, if 
the abdomen be the seat of the injury, there is danger of 
inflammation and ulceration of the duodenum, or small 
bowel. 

Death from burns is, in children, usualty preceded by con- 
vulsions; and it is very rare that a child having convulsions, 
the result of a burn, ever recovers. 

If a child's clothing should take fire those persons who 
may be near by ought not to lose their presence of mind and 
permit the sufferer to run about in the air, thus fanning the 
flames and adding to their destructive ravages. The child 
should be quickly thrown upon the floor and rolled over and 
over upon the carpet. If possible some such article as a 
hearth-rug, or a shawl, or a coat should be thrown over it 
and made to envelop its body as closely as possible. 

It often happens that grown females, who ought to know 
better, finding their dress in flames, rush out into the 
open air screaming for help, instead of lying down upon 
the floor, and, drawing their clothes about them, roll over 
until the fire is extinguished. If they can pull up part 



Accidents and Injuries. 301 

of the carpet and throw it over them, and then roll over 
once or twice until the carpet is closely pressed against the 
body, the fire will soon be extinguished. At any rate, they 
must not stand erect, for, when the body is in an upright 
position, the flames will rush upwards to the head, neck, 
and other important parts. 

Children are often injured by turning the boiling contents 
of a tea or coffee-pot over upon themselves, producing ex- 
tensive scalds. Others fall into vessels of boiling water, 
and in this manner suffer injuries that often prove fatal. 

One of the most dangerous forms of injury from scalds 
is that produced by swallowing the hot contents of a tea or 
coffee-pot. In such cases a physician should be summoned 
without delay, as the swelling of the tongue, mouth and throat 
may threaten suffocation. 

The treatment of burns in children will vary with the na- 
ture and extent of the injury. In the worst cases — those 
endangering the life of the child — the treatment must be 
directed to the general system as well as to the local injury. 

In cases attended with great shock, it may be necessary to 
give stimulating and anodyne medicines; but, as a physi- 
cian should be sent for as soon as possible, medicines of that 
character should be left to his judgment. But if it be im- 
possible to secure his services within a reasonable time, the 
nurse may, if the child is suffering great pain, venture upon 
the administration of two drops of laudanum to a child 
one year old, while older children can take an extra half 
drop for each additional year of their age. The close must 
not be repeated by the nurse, but as soon as the physician 
arrives he should be advised of the measures that have been 
taken for the child's relief. If the patient is cold and shakes 
with rigors, a few drops of the aromatic spirits of ammonia 
in water, or, what is better, in a little ginger tea, can be 
administered. A child six months old can take four or live 



302 The Mother's Hand-Book. 

drops of the ammonia, while one a year old can take eight 
drops, and so on in proportion to age. During the cold 
stage, soft blankets should be gently thrown over the pa- 
tient, and every effort made to restore warmth to the body. 

If there are blisters upon the body, the result of the burn 
or scald, they must be punctured with a needle or the sharp 
point of a pair of scissors, to permit the water to escape, so 
that the dressing can come in closer contact with the diseased 
surface. This should be done with care in order not to re- 
move the skin, which should be left as a protection to the 
surface beneath. 

The burnt surface, whether it be extensive or limited in 
area, must be protected from contact with air. Various 
applications have been recommended in the treatment of 
burns, the primary object of them all being to exclude air 
from the wound. 

In cases of burns not involving those parts of the body 
where the glands are situated, there is no remedy equal to 
white lead. Soon after its application the pain and burning 
cease to a great extent, and the scars left after treatment, if 
the lead has been properly applied, are less than where 
other remedies are used. Some writers have advised against 
its use, believing that if applied over glandular structures it 
might cause " lead palsy "; but it is doubtful if any danger 
of the kind need be apprehended. However, it may be safer 
to omit its use on those parts of the body in which the large 
glands are situated, such as the groins, the arm-pits, under 
the knee-joints, under the jaws, and about the sides of the 
neck. If these localities are the seat of the burns, bis- 
muth, or the oxide or precipitated carbonate of zinc, 
thoroughly pulverized and mixed with linseed oil to the con- 
sistency of thick cream, may be used in the same manner 
as the white lead. In extensive burns, that portion of the 
body where the glands lie may be dressed with the bismuth 



Accidents and Injuries. 303 

or zinc paint, while other portions are covered with the 
white lead. 

Both the white lead and zinc paint must be made very 
thick, so that the heat of the burned part of the body will 
not melt it and cause it to run off the surface. The dress- 
ings should not be removed unless they become foul and 
offensive, or are separated from the surface by the matter 
that forms under them. Frequent changing of the dressings 
must be avoided in all cases. If they become deranged or 
slightly detached, leaving a part of the wound exposed, a 
fresh application of the paint must be made over the old 
dressing, leaving it undisturbed. 

The ground white lead must be mixed with linseed oil to 
the consistency of very thick cream. The thicker it is made 
the better, provided it can be evenly spread over the surface. 

If the face be the part burnt, the lead should be applied 
with a soft brush, and no rag or other dressing ought to be 
placed over it. If the paint becomes rubbed off the burn, 
it must be immediately re-applied, the object being to keep 
it continually covered, permitting no air to come in contact 
with the raw surface. The paint must not be washed or 
rubbed off after it is once applied, but be left to peel 
off without interference. When new skin has formed over 
the burn, the paint and the dead skin will readily come off, 
leaving a healthy surface beneath. The new skin will at 
first be very tender, and vaseline or sweet oil may be applied 
to it occasionally with a feather or camel's-hair brush, until 
it becomes harder and loses its sensitiveness. 

If the burn is situated upon the limbs or parts of the 
body where the clothes or bed-clothing will rub it, the appli- 
cation of the lead must be made in a different manner. In 
such cases it must be gently painted over the burnt surface 
and also spread on well-worn cotton or linen cloths. The 
cloths must then be smoothly laid over the burn, taking care 



304 The Mother's Haxd-Book. 

that there are no wrinkles or other defects in the dressings. 
The dressings should be closely watched, and if they become 
disarranged, leaving a part of the burn exposed, they must 
be carefully re-adjusted. Unless there is a good deal of sup- 
puration from the wound, causing it to become foul and 
offensive, the dressings should be left on until the parts are 
healed. 

Burns often become painful and difficult to heal owing to 
the frequent removal and application of dressings. A burn 
that is not deep, if properly treated, will secrete but little, 
if any, matter. But in those cases where the injury is deep- 
seated, there will be considerable supjDuration, and the abun- 
dant matter will have to be removed by careful washing. 
When the dressings become foul they must be removed and 
new ones applied. This must be done with gentleness and 
care, so as not to irritate the wound and thereby increase 
the inflammation. 

To wash the wound, a sponge should be dipped in tepid 
water and gently squeezed, holding it a little above the sore, 
so as to cause the water to fall on the affected parts until 
they are thoroughly cleansed. After the matter has been 
sufficiently washed off, the sponge should be dipped in fresh 
tepid water to which a little alcohol has been added — say one 
part to six or eight of water — and this should be allowed to 
drop over the surface of the wound. If, after the parts be- 
gin to suppurate freely, the sore does not show signs of 
healing quickly, the white lead may be omitted and a suita- 
ble ointment substituted in its place. If the sore is red, in- 
flamed, and painful, a poultice made of the bark of slippery 
elm, or of flaxseed meal, may be applied each night while 
the inflammation is severe. 

In using these poultices, the material of which they are 
composed should come in contact with the sore, no rag or 
cloth being allowed to touch the inflamed surface. The 



Accidents and Injuries. 305 

poultice should be dispensed with each morning, and during 
the day the sore should be dressed with benzoated oxide of 
zinc ointment, which can be had at any drug store. 

If the sore assumes a white or indolent appearance, a 
stimulating salve — such as the common basilicon or resin- 
ous ointment — should be used. Many persons know how 
to make a salve of mutton tallow, lard, beeswax, and resin, 
which is similar to the basilicon ointment. Poultices should 
never be used on a sore that presents an indolent appear- 
ance, but they should be confined to those characterized by 
inflammation and redness. A pale, indolent sore that is 
slow in healing will be materially benefited by dusting over 
its surface, once a day, a little calomel; and this treatment 
can be pursued in such cases, provided the sore is not too 
large, nor situated over the joints and flexures of the body 
where the glands lie. To apply calomel to a raw surface in 
these localities might possibly produce salivation. 

If the sore is small and not situated over any glandular 
structure, and if it does not heal under the foregoing treat- 
ment, it can be dressed twice a day with calomel ointment. 

The principal mistake made by non-professional persons 
in the treatment of burns, as well as other wounds, is too 
much interference with nature. They not only wash such 
wounds too often, but by rubbing with rags or sponges they 
irritate them. A sore should be cleansed by letting the wa- 
ter from a cloth or sponge fall upon it until the matter has 
been washed away. It can then be dried by gently wiping 
the skin around it with a dry cloth, leaving the sore itself 
to dry without interference. If, in using a poultice, a part 
of it sticks to the raw surface, they are not content until 
they have pulled or washed it loose. This is all wrong, and 
does a great deal of harm. If a poultice is kept wet enough 
while it is applied to a wound (and if it is not wet it will 
do positive harm), it will never stick to the surface. If, 



306 The Mother's Hand-Book. 

however, a part should adhere to the sore, it must not be re- 
moved harshly; but it must be thoroughly wet, after which 
a fresh poultice should be placed over it. 

Deep burns leave ugly scars, for, as the sore heals, the 
adjacent structures are drawn inwards, giving a puckered 
appearance to the parts. 

Sometimes the scars left after the healing of deep burns 
produce so much deformity that a surgical operation becomes 
necessary to correct it. 

If the white lead with which to dress a burn cannot be 
readily obtained, some other article must be used as a tem- 
porary dressing. 

A good immediate application to burns consists of com- 
mon baking soda, to which enough water has been added to 
form a thick paste. This can be spread over the burnt sur- 
face, after which a soft cloth thickly covered with the paste 
can be applied. This dressing should be allowed to remain 
in place until the white lead has been obtained, when the 
burn should be dressed with the latter article. 

Dusting flour, starch, and such articles on burnt surfaces 
should be avoided, for the reason that they soon form crusts, 
which crack, loosen, and injuriously irritate the parts. 

GUNPOWDER INJURIES. 

Children often sustain severe injuries of the face, hands, 
and other parts of the body from the explosion of gunpowder. 

One of the unpleasant results of such injuries is the in- 
delible stain that is sometimes left in the skin. This can to 
some extent be obviated by carefully picking out each grain 
of powder with a sharp-pointed knife. It requires time and 
patience to do this, and, at best, some grains will likely be left. 

Treatment. — These injuries should be treated as burns; 
and the white-lead paint is, perhaps, the best application 
that can be used. In addition to relieving pain and inflam- 



Accidents and Injuries. 307 

mation, it seems to have some effect in preventing discol- 
oration of the skin. 

When the white lead is once applied it should not be re- 
moved; but if any part of the wound becomes bare from 
rubbing or from other causes, a fresh application should 
be immediately made. After awhile the outside skin will 
peel off, leaving the part below tender and sensitive, re- 
quiring the use of a little sweet oil to allay any irritation 
that may be present. 

SWALLOWING FOREIGN SUBSTANCES. 

Children often swallow various metallic substances, such 
as coins, buttons, pins, needles, etc. 

It is rare that any serious effects follow these mishaps, 
and but little need be done in the way of medical treatment. 
After awhile the article that has been swallowed finds its 
way out by the natural passages. Smooth articles, like coins, 
are evacuated with the discharges from the bowels, and to 
satisfy herself that the child has been rid of the offending 
substance, the mother ought to carefully examine the con- 
tents of each stool. In a case that came under my observa- 
tion a small child swallowed a nickle five-cent piece, which 
remained in the bowels for three or four months. The child 
suffered from diarrhoea, and became greatly emaciated; but, 
after the coin passed by stool, it soon regained its health, 
and became as well as it was before the accident. 

Treatment. — When the substance swallowed is smooth, and 
of such shape and nature that it can pass with the stools, 
it is a good practice occasionally to give a dose of castor oil 
to aid the bowels in expelling it. But if a pin, or needle, or 
bit of sharp glass, be swallowed, all purgatives must be with- 
held, as they might do harm. In such cases, it is best to 
feed the child, at rather short intervals, with rice and other 
mild, solid articles, in order that the foreign body may be 



308 The Mother's Hand-Book. 

enveloped by the other contents of the bowels in its down- 
ward passage. 

Needles seldom pass with the stools, but may find their 
way to the surface of the body at almost any point. 

FRACTURES AND DISLOCATIONS. 

Fractures of the bones in children, though painful at the 
time of their occurrence, are not as serious in their results as 
fractures sustained by grown people, especially those who are 
advanced in age. A broken bone in a child, if properly treated, 
may give but little trouble, while the same kind of accident 
occurring in advanced life may result in severe deformity. 

In childhood the collar bone, the thigh bone, the bones of 
the arm and leg, are liable to be broken as the result of falls 
and other mishaps. 

In every case of injuries of this character, the patient 
should be placed in charge of a competent physician with- 
out delay, as a prompt adjustment of the fracture, followed 
by a suitable dressing, is necessary to obviate deformity. 
But until the physician arrives, the child should be placed 
in an easy position, and the injured bone must not be dis- 
turbed unnecessarily. 

If the bones of the leg have been broken, the limb must 
be straightened so as to assume its natural position, and the 
child laid on a mattress or table on which a comfort has 
been folded. A feather bed is too soft and yields too readily 
to pressure, thereby permitting the leg to get out of shape. 

Fracture of the collar bone soon heals in a child, and al- 
though a knot or swelling is usually left for awhile, it will 
in the course of time disappear, leaving no trace of its pre- 
vious existence. 

Fractures of the bones of the arm usually heal readily, 
and after the injury has been properly attended to, the child 
may, in a day or two, be on his feet with his arm in a sling. 



Accidents and Injuries. 309 

Dislocations of the joints are also met with in children. 
The elbow joint is perhaps the one most liable to be dislo- 
cated, though the same injury may happen to the shoulder, 
hip, knee, ankle and wrist. These dislocations are usually 
not hard to reduce, but every case should be treated by a 
competent surgeon, as otherwise deformity, with impaired 
use of the limb, might result. 

SPRAINS. 

If a child suffers a severe sprain, especially of the knee 
or ankle, it is best to seek medical advice, as such injuries 
may be serious in their results and more tedious in recovery 
than the fracture of a bone. Sprains of the joints are fol- 
lowed by stiffness, or loss of freedom of motion. This con- 
dition may last for some weeks; but in children, if there is 
no displacement of a bone, recovery with good use of the 
joint will finally take place. 

Treatment. — A sprained joint should be immersed in water 
as hot as can be borne, for a quarter or half hour, or until 
the pain ceases. After this, flannel wrung out of hot water 
can be kept constantly applied for a day or two. By this 
time the pain will usually have subsided, leaving but little 
swelling. A bandage, nicely adjusted, so as to make even 
pressure on the part, may be worn until the joint can be used 
without much pain. Such a bandage is best made of plas- 
ter of Paris. If the joint remains stiff, it can be bathed 
with a stimulating liniment, gently rubbed with the hand, 
and the parts cautiously worked backwards and forwards, so 
as to overcome any adhesions that may have formed. 

BRUISES. 

A simple bruise, without injury to a bone, is usually of 
trifling importance, and requires but little treatment. A 
cloth dipped in a mixture of alcohol and water, and applied 
to the injured part, is sufficient for the cure of most cases. 



310 The Mother's Hand-Book. 

blows on the head. 

Blows and falls upon the head may be followed by serious, 
results; the skull being fractured in some cases, while in 
others there is concussion of the brain without any fracture 
of the skull. If the brain be seriously injured, the child 
will likely become unconscious, vomit, and have hard, noisy 
breathing. In some cases, however, of severe injuries of the 
kind, no marked symptoms are observed until two or three 
days, perhaps a longer time, after the receipt of the injury. 
But all injuries of the head from falls or blows, that pro- 
duce vomiting and loss of consciousness, are not necessarily 
serious in their results. Grave symptoms may follow slight 
injuries, but in such cases they soon pass away, leaving the 
child as bright as it was before the accident. 

Injuries of the head should be treated by a competent 
surgeon, as it is, in many cases, impossible to say how serious 
the results may be in the future. 

WOUNDS. 

Wounds may be incised, as when made by a knife or other 
sharp instrument; contused, as when the flesh is torn or lace- 
rated; and punctured, as when a nail or other pointed sub- 
stance is thrust into the flesh. Incised wounds are the least 
dangerous and heal the quickest. If there is much bleed- 
ing, it should be arrested by making pressure with the finger 
upon the bleeding point. If there is a mere oozing of blood, 
the probabilities are that, as soon as the cut surfaces are 
brought closely together, it will stop. 

The wound should be well cleansed with warm water, and 
then brought together and held in position by adhesive plas- 
ter. If the cut is very large, one or two stitches with a nee- 
dle and thread may be necessary before the adhesive plaster 
is used. If the wound is painful, or if it swells and is red, it 



Accidents and Injuries. 311 

should be dressed with a cloth dipped in a mixture of alcohol 
and water. 

Contused wounds do not heal as readily as those that are 
made with a sharp instrument. They are apt to suppurate, 
the matter sometimes being profuse. 

Wounds of this character, if severe, should receive medi- 
cal attention at once; but in unimportant cases it will be 
sufficient to apply the alcohol and water dressing for a few 
days, after which, when matter forms, a simple ointment can 
be used to assist the healing process. 

Punctured wounds should receive careful attention, for the 
reason that they sometimes give rise to lock-jaw. There is 
but little danger of lock-jaw following an incised wound; 
but in contused, and especially in punctured, wounds of the 
extremities, as the feet and toes, hands and fingers, such a 
result occasionally happens. 

Punctured wounds should be thoroughly cleansed of all 
foreign substances, and kept constantly wet, either by the 
application of the alcohol and water dressing, or by a poul- 
tice that must not be allowed to become dry. This will keep 
the parts moist and soft, and permit of the escape of any 
matter that may be formed in the wound. 

FROST-BITE. 

From exposure to extreme cold, certain parts of the body 
are liable to be frost-bitten. The ears, nose, fingers and toes 
are especially liable to suffer. 

If the parts are stiff and frozen when first seen, they 
should be bathed in very cold water until the circulation is 
re-established. After this the application of dilute alcohol 
(one part of alcohol to two of water) or spirits of camphor 
will be beneficial. If the surface becomes raw, it should be 
dressed with the oxide of zinc ointment, to which a little 
powdered camphor has been added. 



312 The Mother's Hand-Book. 

During the winter season children often have chapped hands 
as a result of exposure to cold, raw winds. The chapped 
parts may he hathed with a mixture of glycerine and alco- 
hol (two parts of the former to one of the latter), and after- 
wards dressed with calomel ointment or vaseline. 

SORE EARS. 

Infants while nursing may be troubled with sore ears, and 
some mothers have a prejudice against healing them, fear- 
ing that by so doing the child will be rendered liable to have 
disease of the brain. No fears of the kind need be enter- 
tained, and the ear trouble should be cured as soon as possi- 
ble. 

The disease commences at the back part of the ear where 
it joins the head, and involves both the ear and the skin be- 
hind it. Sometimes a crack or fissure forms, separating, for 
a little distance, the ear from the head. Thin matter exudes 
from the sore, and becoming dry, forms scabs which, when 
removed, leave a raw surface beneath. 

The parts must be kept clean by bathing them with rain 
water, after which they should be carefully dried without 
irritating them. The calomel ointment may then be applied 
three or four times a day until a cure is effected. 

LIME IN THE EYES. 

Injuries to the eyes from this cause are very dangerous in 
their nature, as lime is a strong irritant, producing in some 
cases deep ulcers on the front of the eye-ball, which may de- 
stroy the sight. 

If the patient is seen immediately after the accident, the 
eye should be bathed with a mixture of vinegar and water 
(a teaspoonful of vinegar to two tablespoonfuls of water), to 
neutralize the irritant qualities of the lime. The lids should 
be held apart,, and the mixture dropped on the ball. The 



Accidents and Injuries. 313 

parts around the eye should also be bathed with it. A few 
drops of sweet oil may then be dropped into the eye, and some 
rubbed on the adjacent skin. If any particles of lime re- 
main in the eye they must be carefully removed, after which 
the parts should be bathed with warm water, and compresses 
wet with the same must be kept constantly applied until a 
physician can be secured to take charge of the case. 



CHAPTER XXII. 



Occidents mt& Sufttries 

(Continued). 



DROWNING. 



COMPLETE submersion of a person in water is usually 
sufficient to cause death in two minutes. Cases, how- 
ever, have been recorded in which life was restored after the 
body had lain in water for a much longer time. If a per- 
son faints, thereby causing a temporary suspension of respi- 
ration, before being submerged, he may remain in the water 
several minutes without total extinction of life. 

Unless the body is known to have been under water for a 
half hour or more, efforts should be made, according to the 
following directions, to restore life. 

Medical assistance, blankets and dry clothing should be 
sent for without delay; but those present must immediately 
proceed to restore breathing by the following means. No 
crowding should be permitted, and the body must not be al- 
lowed to remain on the back unless the tongue is secured 
and drawn forwards. 

After the patient's mouth has been wiped dry, he should 
be placed with his face downwards and his forehead raised, 
so as to let the fluids escape from his mouth. 

In this position the tongue will fall forward, permitting 
the air to enter the windpipe. 

[3H] 



Accidents and Injuries. 315 

To Excite Breathing. — Turn the patient on his side, at the 
same time supporting his head, and excite the nostrils with 
snuff, hartshorn, or smelling salts, if they are at hand, or tickle 
the throat with a feather. Rub the face and chest briskly, and 
dash cold water, or cold and hot water alternately, on them. 
If these means are unsuccessful, proceed without delay in 
the following manner: 

Place the patient on the back on a flat surface, inclined a 
little upwards from the feet; raise and support the head and 
shoulders on a small firm cushion or folded article of dress 
placed under the shoulder-blades. Cleanse the mouth and 
nostrils, draw forward the patient's tongue, and keep it pro- 
jecting beyond the lips; an elastic band over the tongue and 
chin will answer this purpose, or a piece of string or tape 
may be tied around them. Remove all tight clothing from 
about the neck and chest, especially the braces. 

To Imitate the Movements of Breathing. — Standing at the 
patient's head, grasp the arms just ai)ove the elbows, and 
draw them gently and steadily upwards above the head, 
keeping them in that position for two seconds. By this 
means the air is drawn into the lungs. Then turn the pa- 
tient's arms down and press them gently and firmly for two 
seconds against the sides of the chest. By this means air 
is pressed out of the lungs. Repeat these measures alter- 
nately, about fifteen times a minute, until a spontaneous 
effort to respire is perceived, immediately upon which cease 
to imitate the movements of breathing and proceed to induce 
circulation and warmth. 

Treatment after Natural Breathing has been Be stored. — To 
promote warmth and circulation, wrap the patient in dry 
blankets, commence rubbing the limbs upwards, with firm 
grasping pressure and energy, using handkerchiefs, flannels, 
etc. By this means blood is propelled along the veins to- 
wards the heart. The friction must be continued under the 



316 The Mother's Hand-Book. 

blanket or over the dry clothing. Promote the warmth of 
the body by the application of hot flannels, bottles, or blad- 
ders of hot water, heated bricks, etc., to the pit of the stomach, 
the arm-pits, between the thighs, and to the soles of the feet. 

On the restoration of life, a teaspoonful of warm water 
should be given; then, if the power of swallowing has re- 
turned, small quantities of wine, warm brandy and water, or 
coffee, should be administered. The patient should be kept 
in bed and a disposition to sleep encouraged. 

In all cases that give any hope of recovery, the above 
treatment should be persevered in for some hours, as success 
may sometimes be secured after a long trial. 

INTERNAL POISONS. 

All substances that are poisonous should be carefully kept 
out of the reach of children. It is safest to keep them in a 
chest or drawer securely fastened. , Yet, in spite of the great- 
est caution to prevent such an occurrence, cases of poison- 
ing will sometimes happen, requiring prompt and effective 
treatment. A physician should be sent for, without delay, 
in all cases, and until he arrives the mother should adopt 
such measures as are immediately demanded. 

In nearly every case the first thing to do is to remove the 
poison from the stomach by means of an emetic. Perhaps 
the most useful emetic within a mother's -reach, and one 
that is quite harmless in all cases, is composed of a large 
teaspoonful of strong ground mustard mixed with half a 
teacupful of water. This should be forced down the pa- 
tient's throat without delay. Warm water should be used 
if it can be had without waiting, but if it is not at hand 
cold water will answer. Water should be heated as soon as 
possible and given to the child freely, to encourage vomit- 
ing. Tickling the back of the throat with a feather or the 
finger will also assist in producing vomiting. 



Accidents and Injuries. 317 

If no ground mustard is at hand, salt and water may be 
tried. A teaspoonful of powdered alum mixed with a table- 
spoonful of molasses or water will sometimes produce quick 
vomiting, and is perfectly safe. A teaspoonful of the wine 
of ipecac, or a tablespoonful of the syrup of ipecac, consti- 
tutes a safe and reliable emetic, but it is rather too slow in 
its action to suit cases of poisoning by drugs that are readily 
absorbed. The vomiting should be kept up until the stom- 
ach is thoroughly emptied of its contents. The above di- 
rections apply to all cases of poisoning that are likely to 
occur in a family. 

After the stomach is rid of the poison, it will, in many 
cases, be necessary to follow up the treatment by the admin- 
istration of antidotes. This, however, will be alluded to when 
treating of each separate poison. 

Acids, such as oil of vitriol and aqua fortis, destroy life 
through their corrosive qualities. They burn the parts with 
which they come in contact, and thus produce inflammation. 
The chemical antidote is an alkali (such as common baking 
soda) in water. Soap also answers a good purpose. Oil, 
milk, and plenty of water, or slippery-elm water, should be 
given. As vomiting is one of the results of the irritant ac- 
tion of the acid on the stomach, emetics should not be given, 
for they would not only be unnecessary, but would increase 
the trouble. All such cases should receive skillful medical 
treatment. 

Ammonia, or hartshorn, when taken in large quantities, 
produces inflammation of the stomach. The chemical anti- 
dote is vinegar, which should be administered if the case 
is seen soon after the ammonia has been taken. Copious 
draughts of water should also be given to lessen the cor- 
rosive action of the poison. Slippery-elm water, on ac- 
count of its mucilaginous qualities, is very useful in those 
cases. 



318 The Mother's Hand-Book. 

Sulphate of zinc, or white vitriol, in large doses, is poison- 
ous by reason of its irritant qualities. The treatment con- 
sists in giving warm water to encourage vomiting, after 
which milk with white of eggs should be freely administered. 
An infusion of green tea should be given as a drink. 

Poisoning by belladonna, or deadly nightshade, is some- 
times caused by children eating the berries of the plant. 
The whole plant — berries, leaves and root — is poisonous, and 
should not be allowed to grow about the house or grounds. 

Having sent for the nearest physician, the mother will 
proceed in the same manner as if it were a case of poison- 
ing by opium. An emetic, to produce prompt vomiting, 
which can be encouraged by copious draughts of warm 
water, should be given at once. The child must not be per- 
mitted to sleep, but should be kept awake by the application 
of ice, cold-water sponging, and other measures, until the 
arrival of a physician. 

Camphor, in large doses, is an irritant poison, giving rise 
to faintness, giddiness and delirium, passing, in some cases, 
into drowsiness and convulsions, with cold, clammy skin. 

Emetics should be freely given to rid the stomach of the 
camphor, after which stimulants, such as wine, may be ad- 
ministered. When properly treated, most cases will recover. 

Corrosive sublimate is sometimes kept in houses, in the 
form of a solution in alcohol, for the purpose of destroying 
bed-bugs. It is a deadly corrosive poison, requiring but a 
small dose to destroy life. 

Unless free vomiting has already occurred, the first thing 
to do, in cases of poisoning from corrosive sublimate, is to ad- 
minister a quick emetic, after which the white of eggs should 
be freely given to the patient. If no eggs can be obtained 
quickly, recourse may be had to a mixture of flour and water. 
For the intense thirst it is best to give milk at frequent in- 
tervals, or else the patient can drink slippery-elm water. 



Accidents and Injuries. 319 

Persons who have been poisoned by corrosive sublimate suf- 
fer greatly, and, of course, medical advice should be secured 
as soon as possible. 

Jimson iveed is found growing in many waste places hi 
this country. It is a narcotic poison, and children have 
often been poisoned by eating its leaves or seeds. 

The treatment is the same as that recommended for poi- 
soning by opium and belladonna. 

Arsenic is often used to destroy rats and for other purposes. 
Being sometimes kept in a dresser or cupboard containing 
soda, it has been mistaken for the latter article and used in 
making bread. When arsenic has been swallowed, the pa- 
tient must be vomited without delay. The emetics before 
recommended can be used until free vomiting has been pro- 
duced. After the stomach has been thoroughly emptied of 
its contents by an emetic, or by the irritant action of the poi- 
son itself, fresh milk and the white of eggs should be given. 
For the thirst, which is usually very great, the patient should 
drink water in which slippery-elm bark or sassafras pith 
has been placed. Most cases that do not prove speedily fatal 
will assume a chronic form, and require the care of a skill- 
ful physician. 

Paris green, so often used in destroying the potato-bug, is 
a preparation of arsenic; and cases of poisoning from this ar- 
ticle should be treated according to the directions above given. 

Oxalic acid is sometimes kept about houses for bleaching 
purposes. From its resemblance to Epsom salts it has often 
been mistaken for that article. 

In the treatment of poisoning from oxalic acid, an emetic 
should be given, unless vomiting has already taken place. 
After the stomach has been cleared of the poison by vomit- 
ing, chalk or magnesia suspended in milk or water should 
be freely given. The patient should also drink of mucil- 
aginous fluids, such as slippery-elm water. 



320 The Mother's Hand-Book. 

Poisoning by opium and its preparations not infrequently 
occurs. Of the various preparations of opium, laudanum 
is most commonly used; and as a consequence, poisoning by 
this article is not so very rare. 

If a child is known to have swallowed laudanum, or any 
other mixture containing opium, in poisonous quantities, 
an emetic should be given without delay. Mustard and 
water, salt and water, alum, or ipecac, should be given in 
large doses to insure speedy vomiting. Physicians often 
prescribe in these cases, because of its prompt action, fifteen 
to twenty grains of white vitriol in two or three tablespoon- 
fuls of water. If, however, the more simple emetics, as mus- 
tard and water, produce the desired effects, they should be 
preferred, as the white vitriol may cause unpleasant re- 
sults. After free vomiting, strong coffee should be given 
liberally, and every effort made to keep the child awake 
until the arrival of a physician. If allowed to go to sleep 
he will not likely wake again. He should be walked or car- 
ried about in the open air, and his head and face sponged 
with cold water. If ice can be had, it should be rubbed over 
his forehead, face and neck. If necessary, he can be plunged 
for a few seconds into a warm bath, and then into a cold one. 
By perseverance he may be kept awake in many cases until 
the effects of the opium wear off, when he will be safe. 

Phosphorus is contained in the preparation known as 
" Rough on Rats." It also forms a part of the common 
lucifer match. Poison from either of these articles is usu- 
ally the result of an attempt to commit suicide. 

After the stomach has been cleared of its contents by a 
quick emetic, large doses of calcined magnesia mixed with 
water should be given He should also drink freely of 
slippery-elm water or other mucilaginous fluids. These 
cases are often somewhat protracted in their course, and 
require intelligent and skillful treatment. 



Accidents and Injuries. 321 

Tartar emetic, in large doses, is an irritant poison, producing 
inflammation of the stomach and bowels. The treatment 
consists in encouraging free vomiting by giving large quan- 
tities of warm mucilaginous drinks. The proper antidote 
is a strong infusion of green tea, which should be frequently 
given. After the acute symptoms have subsided, it will be 
well to apply mustard to the stomach, bowels and extremi- 
ties, and give wine freely. 

EXTERNAL POISONS. 

Poison Ivy. — The skin of most persons is very liable to 
become poisoned by contact with the poison ivy, or rhus tox- 
icodendron. While some persons can handle this vine with 
perfect impunity, others cannot go near it, especially at 
night-fall, without being severely poisoned. 

The characteristic symptoms of poisoning by the ivy are 
inflammation and swelling of the skin, with a vesicular erup- 
tion. The vesicles may be small or quite large. Intense 
burning and itching distress the patient, causing him to 
rub the parts, with the effect of rupturing the vesicles and 
increasing the inflammation. 

For several years after an attack the disease is prone to 
recur at the same season without fresh exposure. 

The disease is often spread by the patient rubbing the 
diseased surface and then touching other parts of his body. 
He should, therefore, be instructed to wash his hands im- 
mediately after handling the affected parts. 

Treatment. — The poisoned surface should be thoroughly 
bathed several times a day with a solution of white vitriol (a 
teaspoonful to a pint of water), and after the parts have been 
dried, they should be dressed with oxide of zinc ointment. 
If the solution of white vitriol does not produce beneficial 
results, it may be discontinued, and a sugar of lead wash of 
the same strength can be used. Sometimes the itching is 



322 The Mother's Hand-Book. 

greatly relieved by bathing the affected parts with hot water, 
to which a small portion of alcohol has been added. 

When the inflammation is severe and the skin is raw, 
it is best to use a warm, moist poultice made of flaxseed 
meal or other mucilaginous article. The poultice must be 
kept wet with hot water, to which a small portion of sugar 
of lead has been added, and should be applied at night, 
while other remedies can be used during the day-time. 

As the disease begins to yield to treatment — the inflam- 
mation and itching subsiding — the poultices and wash can 
be omitted, and the parts dressed with oxide of zinc oint- 
ment until they are thoroughly healed. 

POISONOUS INSECTS. 

The sting of a honey-bee, bumble-bee, hornet, yellow- 
jacket, or wasp may cause alarming symptoms in a child. 
These stings produce a wound which is instantly followed 
by a sharp, itching pain, with an inflammatory swelling. 
At the site of injury the skin is elevated and pale. If the 
patient is very susceptible to the influence of the poison, 
the symptoms may become alarming, and consist of dim- 
ness of sight, vertigo, nausea, palpitation, and a feeling of 
oppression, with a disposition to swoon. I have known bees 
to sting the mouth and throat of persons who were eating 
honey gathered in the woods at night. Like injuries have 
been received by persons carelessly drinking cider in which 
bees were floating. 

Treatment. — The wound should be carefully examined to 
ascertain if the sting is left in the skin, and if so it must be 
removed. The parts should then be thoroughly bathed with 
spirits of hartshorn to which a little water has been added, 
or, if that is not at hand, any of the following remedies can 
be used : salt water, alcohol, spirits of camphor, or a strong 
solution of baking soda in water. If the insect has passed 



Accidents and Injuries. 323 

into the throat or stomach, an emetic of mustard and water 
should be given to dislodge it. If the throat is inflamed 
from the sting, a gargle of alcohol, one part to two parts of 
warm water, should be used. If the patient suffers to any 
great extent from the shock — becoming cold with a feeble 
pulse and general depression of the system — it will be neces- 
sary to stimulate him with wine or whiskey. 

SNAKE BITE. 

The principal poisonous snakes in the United States are 
the rattlesnake, the water-moccasin and the copperhead: 
The symptoms produced by the bites of these reptiles vary 
in proportion to the amount and virulence of the poison re- 
ceived into the system. Sometimes a person is bitten through 
the clothing, and but little of the poison reaches the flesh. 
Hence we find that the bite of the most venomous snake 
does not always kill, and in some cases complete recovery 
takes place in a short time after being bitten. Children, 
owing to their lack of vitality as compared to adults, are 
more apt to die from the effects of snake bite than the 
latter. 

A person bitten by a venomous snake will immediately 
feel great pain in the part, followed in a short time by swell- 
ing, which rapidly increases, the affected parts assuming 
a mottled appearance. If a finger or a toe be bitten, the 
swelling soon extends to the body, producing a feeling of 
numbness, weight and coldness, with other symptoms. The 
general system is speedily affected; the patient becomes 
sick at his stomach, and perhaps vomits. He sees objects 
indistinctly, and has frequent swooning fits, with coldness 
and clamminess of the body. The thirst is intense, the 
breathing is oppressed, and the mind wanders. Such are 
the leading symptoms attending fatal cases; but oftentimes 
some of these symptoms are greatly modified, and although 



324 The Mother's Hand-Book. 

the pain and swelling may be considerable, yet after awhile 
they begin to subside, and the patient gradually recovers. 

Treatment. — In some cases, before the arrival of a physi- 
cian, much good can be accomplished by proper treatment. 
If the bite be upon one of the extremities, a cord should be 
put around the limb above the wound and securely tied. 
Then with a sharp knife the flesh around the wound should 
be cut away. Bleeding should be encouraged, with a view 
of carrying off any poisonous matter that may be in the 
wound. 

Alcohol or tincture of iodine should be freely applied to 
the wound, after which it can be dressed with cloths dipped 
in warm water to which an equal part of alcohol has been 
added. 

Internally, whiskey, or, if this is not at hand, alcohol di- 
luted with water (one part of alcohol to two of water) should 
be freely given, so as to produce slight intoxication, which 
should be kept up for several hours. 

FOREIGN BODIES IN THE EAR. 

Various substances are liable to get into the ear, either by 
accident or design, the most common being grains of coffee, 
corn, peas, beans, cherry-stones, as well as bugs and other 
insects. The effects of such accidents vary according to the 
nature, size, and shape of the foreign body. If a grain of 
corn, or similar substance, remains in the ear for a few days 
it will swell and become larger, thus causing increased diffi- 
culty in its extraction. A smooth substance gives less pain 
than a rough one, while bugs and other living insects cause 
the greatest distress by their movements and the buzzing 
sounds they make. 

Treatment. — If the substance is small and relatively heavy, 
the patient can be laid on his side with the affected ear 
below, and the head quickly shaken with a view of dis- 



Accidents and Injuries. 325 

lodging the intruder, so that it will, by its gravity, drop 
out. 

If the foreign body be alive, the child should be placed 
on its side with the sound ear below, and warm sweet oil or 
melted lard poured into the affected ear, for the purpose of 
killing the insect and preventing its further movements. If 
the insect be small, it will float on top of the oil, where it 
can be seen and easily removed. 

Failing to remove a foreign body in this manner, how- 
ever, recourse must be had to syringing the ear with warm 
water. To do this properly the syringe should hold about 
four ounces of water and have a long slender nozzle, which 
should be introduced to a sufficient depth to enable the 
stream to pass by the side of the object to be removed. 
The operator should seize the lobe of the ear and draw it 
upwards and backwards, so as to straighten the canal, and 
then introducing the nozzle of the syringe, he should push 
the piston with sufficient force to dislodge the intruder. If 
a large syringe is used, the piston must not be pushed too 
forcibly, as rupture of the ear-drum might result. During 
the operation the patient should sit up in a chair with his 
head slightly inclined to the affected side, to favor the ex- 
pulsion of the foreign body. A large white cloth or paper 
should be laid on the floor beneath the patient, so that an 
examination of the discharge from the ear will reveal whether 
the substance has been removed or not. 

If these measures fail of success, it will be necessary with- 
out delay to take the child to a surgeon for treatment. 

FOREIGN BODIES IN THE EYE. 

Different substances, such as dirt, ashes, lime, barley- 
beards, gnats, and other small insects are liable to get into 
the eye, causing pain and inflammation. They are usually 
imbedded under one of the lids, but occasionally they may 
be found adhering to the eye-ball. 



326 The Mother's Hand-Book. 

Treatment. — The foreign body should be removed as soon 
as possible, after which warm water must be constantly ap- 
plied until the inflammation has subsided. Standing be- 
hind the patient, who is seated in a chair facing a good 
light, the operator raises the eye-lid and tells the patient to 
move the eye about in different directions, so as to expose 
all parts of the eye-ball. Any foreign substance that can be 
seen lying loosely on the eye-ball, or under the lids, can be 
easily removed with the corner of a silk handkerchief or a 
fillet of paper. If the substance be a barley-beard, or any- 
thing that adheres closely to the parts, it will be necessary 
to use a pair of small tweezers to effect its removal. 

When small particles of steel, glass, or other sharp ar- 
ticles are driven into the eye-ball, and cannot be extracted 
in the above manner, it will be necessary, without delay, to 
take the patient to a skillful surgeon. 

After the foreign substance has been removed, frequent 
bathing of the eye with warm water, and the application of 
compresses dipped in the same, will soon restore the organ 
to a healthy condition. 

FOREIGN BODIES IN THE AIR-PASSAGES. 

Foreign bodies of various kinds occasionally enter the 
air-passages, giving rise to the most serious symptoms. Of 
the many articles that are liable to become impacted in the 
windpipe of children, small coins, buttons, cherry-stones, 
melon-seeds, and grains of corn are the most common.. 
After once entering the air-passages the substance, if it 
is of any size, will usually be arrested in the larynx. 
If small, and especially if heavy, it is liable to pass 
through the windpipe and lodge in one of the large bron- 
chial tubes — usually the right one. Sometimes a foreign 
body, such as a grain of corn, or a melon-seed, passes 
through the larynx and remains loose in the windpipe be- 



Accidents and Injuries. 327 

low, being carried upwards and downwards with each, act of 
respiration. 

When a foreign body enters the air-passages, it imme- 
diately produces a great deal of distress and paroxysms of 
severe coughing. The patient gasps for breath, clutches his 
throat, coughs violently, while froth, or froth and blood, es- 
capes from his mouth and nose. These symptoms may con- 
tinue for a few seconds only, or they may last for hours. If 
the foreign body remains in the larynx the acute symptoms 
will continue; but if it drops into the windpipe below, some 
temporary relief may follow. The paroxysms of coughing 
and difficult breathing will return, however — permanent re- 
lief being obtained only by expulsion or removal of the 
offending substance. In some cases the symptoms are not 
at all urgent, the patient complaining of but little inconve- 
nience, and it may be difficult to determine whether there is 
really a foreign substance in the air-passages or not. 

A foreign body may be expelled by coughing soon after 
it has entered the windpipe, or expulsion may take place in 
this manner weeks or months afterwards. Cases have been 
recorded where a foreign, substance, after remaining in the 
air-passages for a year, was finally expelled by coughing. 

Recovery does not always take place after the expulsion 
or removal of a foreign body, for, before its removal, it may 
have caused enough irritation and ulceration of the wind- 
pipe and bronchial tubes to produce' death. 

When buttons, coins, or other metallic substances get into 
the air-passages they are rarely expelled by natural efforts. 
The surgeon will, in nearly all such cases, be compelled to 
open the windpipe to remove them. When, however, a 
green melon-seed or like mucilaginous substance enters the 
air-passages, the probabilities are that after awhile it will be 
expelled by the patient Avhile coughing. Several weeks, 
however, may elapse before the child coughs it up. 



328 The Mother's Hand-Book. 

Treatment. — Although a surgeon should be summoned in 
all eases, yet before his arrival efforts to relieve the child 
should be made by those present. The patient should be 
suspended by the heels, or his body can be securely held on 
a bed or table with his head inclined downwards. While in 
this position his chest and back should be sharply and re- 
peatedly struck with the hand in order to dislodge the sub- 
stance from the windpipe. This operation should not be 
continued too long at a time. In fact, in some cases, inver- 
sion of the body adds so much to the danger of suffocation 
that it cannot be safely practiced. Snuff, and similar arti- 
cles, can be applied to the nostrils to induce sneezing, which 
sometimes aids in the expulsion of the foreign body. These 
means failing, the case will pass into the hands of the sur- 
geon, who may be compelled to open the windpipe before 
relief can be obtained. 

FOREIGN BODIES IN THE NOSE. 

Children not infrequently place into the nose, as a matter 
of amusement, such articles as grains of corn, peas, beans, 
buttons, fruit stones, etc. If they remain in the nose long 
they always produce inflammation and ulceration, attended 
with an offensive discharge. When an accident of this kind 
happens to a child, the mother always becomes greatly ex- 
cited, and usually makes fruitless attempts to extract the for- 
eign body, with the effect of pushing it still further into the 
nostril. 

Treatment. — The accident is unattended with danger to 
life, and relief can be obtained easily by proper procedure. 
Sometimes a pinch of snuff, placed in the nostril to cause 
sneezing, while the other nostril is closed, will be sufficient 
to expel the intruding substance. 

With a piece of small annealed wire bent upon itself in 
such manner as to form a curved loop at one end, small 



Accidents and Injuries. 329 

enough to enter the nostril, these substances can usually be 
extracted without difficulty. The wire should be pushed 
gently backwards and upwards until the loop is above and 
behind the foreign body, after which the loop should be de- 
pressed so as to get behind the substance, which can then 
be readily pulled forward out of the nostril. 

CHOKING. 

A child may fill its mouth so full of meat, or other article 
of food, that in attempting to swallow it he becomes choked. 
Ordinarily the trouble is soon overcome, but I have known 
death to speedily follow choking by large bits of meat. As 
soon as possible a finger should be inserted into the child's 
throat, and if the substance be within reach it should be 
hooked out at once. If it can be digested, and is too far down 
the throat to be removed by the finger, it should at once be 
pushed downwards until it reaches the stomach. If the child 
be choked on any article that is not proper to be swallowed, 
and if it is impossible to remove it, the back of the throat 
should be tickled with the finger, or a feather, until vomit- 
ing occurs, when the substance will usually be discharged. 

ACCIDENTS FROM LIGHTNING. 

A person struck by lightning may be killed outright, or 
he may remain insensible, with slow respiration, scarcely 
perceptible pulse, and dilated pupils, for periods varying 
from a few moments to an hour or longer. The latter con- 
dition may be followed by complete recovery, or there may 
remain paralysis of the limbs (usually the lower), and de- 
rangement of the special senses, the patient losing his power 
of speech, sight, or hearing. The paralysis may be per- 
manent, but in many cases it disappears after a lime, and 
even the special senses may return to their normal condi- 
tion. 



§80 The Mother's Hand-Book. 

Other affections that may be caused by lightning are burns, 
eruptions on the skin, loss of hair over parts of the body, 
wounds, and hemorrhage from the mouth, nose, or ears. 

Lightning is apt to be attracted by any metal worn about 
the body. Watch chains have been broken and melted, and 
by the intense heat of these metallic conductors the cloth- 
ing has been set on fire. 

In some cases the clothing is torn and burnt to a great 
extent, and strong boots have been burst open or thrown off 
the feet to quite a distance. 

The treatment of shock from lightning consists in arousing 
and keeping up the circulation and respiration. Dashing 
cold water over the body, combined with friction and warmth 
to the extremities, and the injection of whiskey or brandy 
into the bowels, may aid nature in overcoming the shock to 
the nervous system. 

Irritating the mouth and nose with the fumes of spirits 
of hartshorn, and, in some cases, artificial respiration as di- 
rected in cases of drowning, may be useful. 

The patient should have plenty of fresh air, and persons 
should not be permitted to crowd around him. 

Burns that have occurred upon the body should be treated 
according to the directions given in the article on that sub- 
ject. 



CHAPTER XXIII 



3$li$ci»lfaneou$ Sltseases 



VACCINATION. 



AS small-pox is extremely fatal in infantile life, it becomes 
especially necessary to guard young children from an 
attack of the disease. If convenient, every healthy child 
should be vaccinated at an early age. When small-pox 
is prevailing in the neighborhood, an infant should be vac- 
cinated when a few days old; but if there is no immediate 
cause to fear an attack of the disease, the operation should 
be deferred in healthy infants until they are four to six 
weeks old; and if the child be weakly, it is best to postpone 
the vaccination a month or so longer. In small towns and 
in the country, it is often difficult to obtain a good article of 
vaccine virus, and children living in such places are usually 
not vaccinated until later in life. 

Unless the danger of exposure to small-pox is great, no 
sick or very unhealthy child should be vaccinated. It is 
best to wait until it has recovered its health, or has sufficient 
strength to withstand, without danger, the sickness to which 
vaccination gives rise. Of course, where the child has been 
exposed to small-pox, or when the surroundings are such 
that exposure to the disease may occur at any time, it is 
proper to protect it by vaccination without delay. 

The selection of the vaccine virus is of great importance. 
There are two kinds: the bovine, or animal, and the human 

[331] 



332 The Mother's Hand-Book. 

virus. It is claimed for the animal virus that by its use 
there is no danger of inoculating the system with other dis- 
eases, as scrofula, syphilis, etc., and that it affords better 
protection against small-pox than does human virus. 

But if the virus be taken from a healthy infant, in whom 
the vaccine disease ran its regular course, without any 
complications whatever, there need be no fears of inoculat- 
ing the child with other diseases. Besides, if the virus is 
not too far removed from the animal product, it is just as 
efficacious as the latter. The objection to virus taken direct 
from the animal is that it sometimes produces great swelling 
and inflammation of the arm, with a high grade of fever. 
The best virus is that which has been obtained from the calf 
and afterwards humanized by passing it through the systems 
of a few healthy children. 

Vaccination is best performed when the lymph is taken 
directly from the vaccine sore on the sixth, seventh or eighth 
day, and used immediately. But as this can seldom be done, 
lymph that cannot be used within a few hours should be 
stored in hermetically-sealed .tubes, or on points thickly 
coated with it, and kept constantly protected from damp and 
heat. When used, the points of lymph should be dipped in 
water and laid on a piece of glass until the matter is soft 
enough to use. 

Vaccination is usually practiced in this country from the 
crust that falls off from a vaccine sore. The first crust pro- 
duced by the sore is the only one that is fit to use. It should 
be kept dry and cool, and may be enclosed in a piece of 
white wax to protect it from the air. When used, the edges 
and top of the crust should be carefully trimmed away, so 
as to expose the inside portion, a small fragment of which 
is placed upon glass and a drop of water added, and inti- 
mately mixed with the virus. The arm being slightly scari- 
fied, or scratched, until it is raw, but not bleeding, the mat- 



Miscellaneous Diseases. 333 

ter is taken from the glass on the point of a lancet or small 
knife and placed on the raw surface and left to dry. After 
the arm is thoroughly dry, a small piece of court-plaster 
can be put over the sore to prevent the clothes from rub- 
bing it. 

If considerable fever arises as a result of the vaccination, 
a mild purgative may be administered, and the diet of the 
child restricted to the mildest articles. 

Sometimes from rubbing and irritating the parts a trou- 
blesome sore is produced on the arm, and the glands in the 
arm-pits become swollen and painful. This, together with 
the inflamed and painful condition of the arm, calls for spe- 
cial treatment. The sore should be enveloped in a warm, 
moist poultice, which should be changed frequently. Each 
time the poultice is changed the arm should be bathed 
with a mixture of warm water and alcohol. After the in- 
flammation and swelling subside, the sore can be dressed 
with the oxide of zinc ointment until it has healed. 

PURPURA. 

This is a disease in which extravasations of blood take 
place into the skin and in the substance of different organs. 
Hemorrhage may also occur from mucous surfaces, and into 
the various cavities of the body. When the extravasations 
take place into the skin only, the disease is called simple pur- 
pura; when the hemorrhage is more general, the blood flow- 
ing from the nose, mouth, bowels, etc., it is known as pur- 
pura hemorrhagica. 

Purpura is sometimes met with in children, and may be 
caused by insufficient food, by food of a poor quality, and 
by bad hygienic surroundings. The disease may be due to 
heredity, to valvular disease of the heart, or it may follow 
exhausting diseases of various kinds. In some cases it is 
impossible to ascertain its cause. 



334 The Mother's Hand-Book. 

In simple purpura the spots may appear without previous 
signs of ill health. Usually, however, "before the appearance 
of the extravasations, the child complains of aching in the 
limhs; it has slight fever with thirst, and its digestion is im- 
paired. The spots are circular in shape, and are of a hrick 
red or dark purplish color. In size, they vary from a pin's 
head to the diameter of half an inch or more. Sometimes 
they are accompanied hy marks that look like bruises, which 
are clue to extravasation of blood into the tissue beneath 
the skin. 

In purpura hemorrhagica the effusion of blood is not con- 
fined to the skin and the tissue beneath it; but it may occur 
from the nose, the gums, the stomach, the bowels, the kid- 
neys, or from other parts. If hemorrhage proceeds from 
the bowels the blood is passed in the form of dark clots, 
which are deposited in the bottom of the vessel. The joints 
may be the seat of pains and considerable swelling, often 
leading to the supposition that the patient has rheumatism. 

In severe and protracted cases the child becomes weak, 
the ankles and face may be swollen or puffed, and sometimes 
convulsions take place, due to effusion of blood into the ven- 
tricles of the brain. 

The disease varies greatly in its duration, but if properly 
treated it usually ends in recovery. 

Treatment. — Rest in bed is important in the management 
of jmrpura. "When the disease comes on suddenly in an 
otherwise healthy child, purgative medicines, such as syrup 
of rhubarb, or syrup of rhubarb and senna, or castor oil, to 
which a few drops of turpentine have been added, will be 
beneficial. In the hemorrhagic form Fowler's solution of ar- 
senic with the tincture of perchloride of iron will be useful. 
The fluid extract of ergot with gallic acid has also been used 
with benefit, but these remedies should be prescribed by a 
physician only. 



Miscellaneous Diseases. 335 

When the child becomes weak from loss of blood, port 
wine or some other stimulant should be administered, and 
milk and other nourishing articles of diet must be given. 

The gums of a child suffering from purpura must not be 
lanced; and before performing such an operation on any 
child the physician should examine its body to see if any 
purple spots be upon it. Neglect of this precaution may 
sometimes result in serious consequences. 

bleeding from the nose. 

Bleeding from the nose may be caused by congestion of 
the blood-vessels of the head, by blows or other injuries on 
the nose or forehead, or by a disordered condition of the 
blood, as in purpura and other diseases. 

When there is congestion of the blood-vessels of the head, 
accompanied with headache, bleeding from the nose, unless 
excessiye, is beneficial and ought not to be interfered with. 
When it proceeds from other causes it should be arrested 
without delay. The bleeding rarely proves fatal unless it 
happens in a patient who is affected with purpura hemor- 
rhagica. 

Persons who -drink large quantities of milk daily are, 
owing to the rapid formation of blood, sometimes affected 
with bleeding from the nose. I have sometimes, under such 
circumstances, been compelled to advice the patient to ab- 
stain from the use' of milk before the bleeding could be per- 
manently controlled. 

Treatment. — Sometimes pressing both sides of the nose to- 
gether with the thumb and fore-finger will arrest the bleed- 
ing. This must be continued for a long time. If ice be at 
hand, a piece of it can be enveloped in a fold of flannel and 
applied to the forehead and to the sides of the nose, chang- 
ing it occasionally from one position to another, for it should 
not be applied too long at one place. If no ice can be had. 



336 The Mother's Hand-Book. 

a cloth dipped in cold water can be used in its stead. Ice 
or cold cloths to the nape of the neck should be tried. If 
the child is old enough to do so, it should snuff up the nos- 
trils a little tannin or powdered alum. If these measures 
fail, the hands and arms of the patient can be plunged into 
cold water for a few minutes, and then held up high above 
the head, and kept in that position for some time. If the 
bleeding still continues, a surgeon must be called, who will, 
if the hemorrhage be dangerous, proceed to plug the nos- 
trils — an operation that is free from danger and easily per- 
formed. 

EAR-ACHE. 

This painful affection is commonly caused by exposure of 
the child to a draught of cold air. 

The pain usually depends upon a catarrh or inflammation 
of the middle ear and the little tube that leads from it to the 
throat. The trouble ordinarily begins as a slight cold; the 
child is somewhat feverish and restless, moving its head 
about uneasily on the pillow. It becomes fretful, looks 
distressed, and cries in a piteous tone. Occasionally it has 
fits of violent screaming, causing much alarm to the 
mother, who often concludes that her child has brain dis- 
ease. The cry that accompanies ear-ache is peculiar, and 
once heard can be recognized afterwards. The child sleeps 
for a short time, and awakes suddenly in a fit of violent 
crying. 

To detect ear-ache, the mother should wait until the child 
ceases crying and has become quiet. Then gently placing 
her finger on the ear-tube, she should make slight pressure. 
If the ear be inflamed, and the seat of the pain, the child 
will immediately scream out in great agony. If it does not 
seem to mind the pressure, the other ear must be tried in 
the same manner. If pain is not produced by pressure on 
either ear, the trouble is elsewhere. 



Miscellaneous Diseases. 337 

Many cases of ear-ache caused by exposure to cold soon 
recover under judicious management. Occasionally, how- 
ever, the inflammation is followed by the formation of mat- 
ter in the ear, and by impairment of the child's hearing. 
Therefore, if the ear-ache does not yield to treatment in a 
reasonable time, medical advice must be obtained. 

Treatment. — If the child is feverish, and the bowels some- 
what constipated, a dose of syrup of rhubarb or castor oil 
should be given. A little sweet oil, as warm as can be well 
borne, may be dropped into the ear, and confined there by 
a small piece of cotton placed in the tube. But the main 
treatment consists in applying warm compresses, or poul- 
tices, to the side of the head, large enough to thoroughly 
envelop the ear. 

An excellent application is made by using a small flannel 
sack filled with wheat bran, which, after being dipped into hot 
water, should be gently squeezed and placed on a pillow that 
has been covered with a piece of oil-silk or oil-cloth. The 
child's head can then be laid on the sack, so that the affected 
ear shall be kept constantly pressed against the warm bran. 

If wheat bran cannot be had, any good hot poultice will 
do, as heat and moisture are the principal factors in the re- 
lief of the pain. Of course, after using the warm applica- 
tions (which should be kept up until the pain ceases), care 
must be observed to prevent the child from taking cold after 
their removal. This can be done by keeping it in a com- 
fortable room for a day or two, and if it then becomes neces- 
sary to change rooms, the head can be protected by a light 
covering. 

INCONTINENCE OF URINE, OR WETTING THE BED. 

Incontinence of urine, or an inability to control the action 
of the bladder, is an infirmity from which children not in- 
frequently suffer. The complaint may exist in either sex, 

22 



338 The Mother's Hand-Book. 

and is often very difficult to cure. Indeed, in some cases, 
the affection continues up to the period of puberty. Although 
the disease may exist during the day, yet it is more apt to 
occur in the night, causing the child to wet its bed while 
sleeping. 

Ordinarily the trouble begins as the result of some de- 
rangement of the system. Worms in the lower bowel may 
give rise to it. A highly acid condition of the urine, pro- 
ducing irritation of the bladder, may cause it. In other 
cases it depends upon some disorder of the stomach and 
bowels. Often the cause of the disease cannot be ascer- 
tained. After awhile a habit of wetting the bed is estab- 
lished, which is exceedingly hard to overcome, even after the 
general health has been fully restored. 

In rare cases there is an entire lack of control over the 
bladder in the day-time, the urine constantly dribbling from 
the child, or the desire to pass water is felt at short inter- 
vals, and the patient is unable to resist it even for a minute. 
These severe cases occur more frequently in girls than in 
boys, and are exceedingly troublesome, and hard to cure. 

The treatment of children addicted to wetting the bed re- 
quires a great deal of care and attention on the part of the 
nurse. The quantity of drink taken at the last meal and 
before bed-time must be limited. The bladder must be emp- 
tied before the child goes to bed, and once or twice during 
the night it should be aroused from sleep to enable it to void 
its urine. To prevent it from lying on its back while sleep- 
ing, it is best to give it a soft bed and a hard pillow. The 
diet should be mild, but nourishing, and taken in quantities 
not too large at a time. Plenty of exercise in the open air 
should be taken, for the purpose of giving tone and strength 
to the system. 

The treatment of this infirmity by medicines should be 
conducted by a physician only, as the remedies ordinarily 



Miscellaneous Diseases. 339 

used are dangerous unless given in proper doses and at suit- 
able intervals. 

WARTS. 

Small growths, called warts, are often found seated on the 
skin, causing considerable inconvenience and disfigurement. 
That warts have a direct relation to the nervous system is 
shown by the fact that they sometimes disappear under the 
influence of mental emotion, which accounts for the sup- 
posed efficacy of certain charms in their cure. 

Warts are usually situated on the hands, but they may 
exist on other portions of the body. They may be single, 
or several maybe joined together, forming clusters. A wart 
may sometimes be mistaken for a cancer of the skin (epi- 
thelioma), but in the latter disease there is pain, or a burning 
sensation in the part, and infiltration or swelling in some of 
the glands lying near it. 

Treatment. — After paring away the outer layer of the wart, 
a drop or two of strong acetic acid can be placed on it with 
a pointed stick. This application can be repeated daily 
until the wart disappears. Chromic acid is also a valuable 
agent in the destruction of these growths. After shaving 
off the outer or hard portion of the wart, a little chromic 
acid can be applied and allowed to remain for a minute or 
two. This will usually accomplish the desired purpose with- 
out producing a troublesome sore. Tincture of iodine or 
spirits of turpentine will sometimes, after repeated applica- 
tions, remove warts. 

The stronger caustics, such as nitric acid, will speedily de- 
stroy warts; but their use will often be followed by trouble- 
some and painful sores. 



CHAPTER XXIV. 



Miscellaneous Sttfafects. 



DISINFECTANTS. 

IN cases of small-pox, cholera, scarlet fever, diphtheria, 
typhoid fever, and other contagious and infectious dis- 
eases, much can be done to arrest their spread by means of 
thorough disinfection. When a case of such disease appears 
in a house the following precautions should be taken. The 
patient ought at once to be removed to a suitable room — 
preferably an upper one — and isolated from other persons 
except the nurse. The room should be large and airy, capa- 
ble of being properly ventilated, and should contain no extra 
furniture, carpets, curtains, or other article not needed for 
the patient's welfare and comfort. 

By placing a piece of oil-cloth under the sheet or blanket 
upon which the patient rests, the bed will be protected from 
any discharge that may escape from his body. 

The room should be kept clean, but before being swept 
the floor must be sprinkled with some disinfecting solution. 
An open fire-place permits the foul air to escape from the 
room, and fresh air can be admitted through the window 
without a draught by the following arrangement. Raise the 
lower sash three inches, and fit a board accurately in the 
window at the bottom of the raised sash. This will prevent 
any draught, and at the same time permit the air to enter the 
room at the point where the upper and lower sash meet. 

[340] 



Miscellaneous Subjects. 341 

All articles from the bed and the patient's body, after 
being soiled, should be submerged in a disinfecting solution, 
after which they must be washed separately, and not mixed 
with the general household articles. A disinfectant should 
be placed in the vessels in which the discharges from the 
bowels are received, and such discharges must be removed 
from the room and buried in the ground far away from any 
well or cistern. 

All handkerchiefs or .rags used to cleanse the patient's 
mouth or nose must be burned soon after being soiled. 

Basins containing water into which some disinfectant has 
been placed should be handy, and the nurse and others 
must wash their hands in it after handling the patient. 

No articles of food or drink from the sick-room should be 
consumed by others. 

No visitors should be admitted to the sick-room except in 
cases of necessity. 

When a patient recovers and is considered free from in- 
fection, or, in case of death, after the removal of the body, 
the room and its contents must be thoroughly cleansed and 
disinfected. The ceilings and walls should be scraped and 
whitewashed. 

The bed-clothes and wearing apparel must be thoroughly 
disinfected before removal from the sick-room, after which 
they should be boiled and washed. Beds, pillows and other 
articles which are intended to be used must be soaked in a 
disinfectant fluid, after which they should be dried on the 
roof of the house or in an empty room. 

All articles of filth and refuse must be removed from the 
premises, and disinfectants freely used. Cellars, garrets, 
sleeping rooms and other apartments should be thoroughly 
aired during the day-time. 

Children living in houses in which there is a case o( con- 
tagious disease must not be allowed to attend school. 



342 The Mother's Hand-Book. 

In cleansing the body of a corpse a solution of chloride 
of lime, one pound to a gallon of water, may be used. The 
whole body should be washed with this solution. All cloths, 
sponges, etc., used about the dead body must be burned. 
Under the hips of a corpse may be placed a large layer of 
cotton batting, well soaked with the chloride of lime solu- 
tion, to absorb any discharges that may flow from the body. 

Persons dying of infectious diseases should be buried soon 
after death. 

HOW TO USE DISINFECTANTS. 

Quicklime. — This agent is used to absorb moisture and 
putrid fluids. It is also used to whitewash walls after sick- 
ness from infectious diseases. 

Chloride of Lime. — This destroys putrid effluvia and ar- 
rests putrefaction. Plates containing chloride of lime can 
be placed about the room occupied by a person with infec- 
tious disease. When used to destroy foul odors in cellars or 
close rooms, pour strong vinegar on it, so as to release the 
chlorine contained in it. When vinegar is used it will be ne- 
cessary occasionally to add fresh chloride of lime to the mass. 

Copperas. — This is used to disinfect drains, sewers and 
places and grounds where discharges from patients with 
cholera, typhoid fever, etc., are placed, as privies and cess- 
pools. For this purpose copperas is superior to carbolic 
acid, but it must be remembered that it discolors most arti- 
cles with which it comes in contact. Carbolic acid should, 
therefore, be used for disinfecting clothes, towels and simi- 
lar articles, as well as for sprinkling upon the floor, window 
sills, and all parts of the house covered by paint. 

To make a solution dissolve two pounds of copperas in one 
gallon of water, and stir briskly until thoroughly dissolved. 

Carbolic Acid. — Add one and a quarter ounces pure car- 
bolic acid in a fluid state to the same quantity of vinegar, 



Miscellaneous Subjects. 343 

and dissolve this in a gallon of water. This is used to dis- 
infect clothing, towels, and like articles. After being thor- 
oughly disinfected with this solution, the clothing may he 
washed in strong soap-suds. Articles that can he boiled 
must be submitted to that process for at least one hour 
before being washed. 

The clothing can be boiled within a few hours after being 
soiled; it must in all cases be soaked in the carbolic acid 
solution before being washed. 

Cellars, vaults, stables, and damp, foul places should be 
disinfected by the liberal use of quicklime sprinkled about 
the contaminated places. 

A solution of carbolic acid should be sprinkled on the 
floor and window-sills of sick-rooms and closets, and a solu- 
tion of copperas, in earthen vessels, may be placed about the 
rooms. 

Water-closets, privies, etc., should be disinfected by a free 
use of the copperas solution. A pint of the solution may 
be used to each privy or water-closet, morning and night. 

Discharges from the bowels of the sick should be wet with 
copperas water and then buried. 

Soiled clothing, etc., from the sick should be placed in a 
tub, and enough of the carbolic solution added to wet them 
thoroughly. After remaining an hour or two in the solution 
they must be thrown into hot water and boiled for at least 
an hour, and then well washed in strong soap-suds. 

Woollen goods must be exposed to the fumes of burning 
sulphur in • a close room, and afterwards hung out in the 
open air. 

FUMIGATION. 

After some diseases, such as small-pox and cholera, as well 
as bad cases of scarlet fever, it is necessary to fumigate the 
sick-room after the patient has left it, to destroy any germs 
of the disease that may be contained in it after the use of 



344 The Mother's Hand-Book. 

disinfectants. When this is to be done, such articles as car- 
pets, thick woollen goods, and the furniture should be left in 
the room, and all the openings closed, and even every crack 
well stopped. Then take an iron pot, or other suitable ves- 
sel with legs, and place it in the centre of the room. After 
arranging a hearth of bricks or rock, so as to be safe from 
fire, throw into the vessel enough powdered sulphur to last 
for eight hours. Provide enough fuel to last that time. 
Kindle a fire beneath the vessel, and immediately vacate the 
room, closing the doors tightly. Let the room remain closed 
for eight hours, after which the doors and windows should 
be thrown wide open. After the fumes of the sulphur have 
disappeared the wood-work and walls should be washed with 
soft-soap suds, to which carbolic acid has been added. If 
the walls have been papered the paper must be stripped off, 
or if they have been whitewashed they must be scraped, and 
afterwards a good coat of whitewash, to which a little car- 
bolic acid has been added, must be applied to them. After 
this the windows should be kept open for thirty-six to forty- 
eight hours before the room is again occupied. 

A person who has never had small-pox and is compelled 
to enter a room that is occupied *by a patient with the disease, 
should take a thick veil (such as women often wear in the 
country) and, after folding it two or three times, soak it in a 
strong solution of copperas. Then place it around the head 
and over the face in such manner that the breath shall 
come through the meshes of the veil. By following these 
directions the probabilities are that the person will not con- 
tract the disease. 

HEREDITY. 

Disease, like certain family peculiarities, is often trans- 
mitted from parent to child. The hereditary taint in a child 
may be traceable directly to the parents, or it may skip a 
generation, when, although the father and mother may be 



Miscellaneous Subjects. 345 

seemingly healthy, a careful inquiry will disclose the fact 
that the grandparents, one or both, suffered from the disease. 
In such cases the probabilities are that in the parents the 
tendency to the disease really existed, but owing to the ex- 
cellent sanitary conditions surrounding them, the causes ne- 
cessary to develop it were absent. 

If both parents be affected with a constitutional disease, 
the children are almost certain to suffer from the same in- 
firmity; but if one parent be healthy the chances are that 
by careful management some of the offspring may entirely 
escape. 

Occasionally the hereditary affection is displayed at birth, 
but in most cases it is not developed until some time after- 
wards. It is not always the case that a child suffers from 
the precise disease that afflicted its parents. Thus, for 
instance, the offspring of consumptives may be scrofulous, 
while those born of scrofulous parents may have consump- 
tion. The children of syphilitic persons are often scrofu- 
lous, while cancer may, in after-life, attack those whose 
parents were either consumptive or scrofulous. 

Therefore, while the same disease may be transmitted from 
parent to child ? such is not always the case; but often the 
offspring will suffer from the effects of such transmission 
by becoming a victim of a disease having a close kinship to 
that with which its parents were afflicted. This is especially 
the case in nervous affections, for while the child of an in- 
sane parent may not become insane it will be very liable to 
have some other form of nervous disease, such as epilepsy, 
hysteria, mental instability, or weakness of will. If, in ad- 
dition to being affected with a constitutional disease, both 
parents possess the same family idiosyncrasies, they are 
almost sure to transmit the disease from which they suffer 
to all their children. Hence the danger of the intermarriage 
of cousins, or others nearly related by blood, as the offspring 



346 The Mother's Hand-Book. 

of such marriages are liable to inherit not only the physical 
disease, but also the mental peculiarities of the parents in 
an intensified degree. 

While every one understands that consumption, scrofula 
and syphilis may be transmitted to the offspring of those 
suffering from such diseases, but few are aware of the extent 
to which the law of hereditary transmission applies to dis- 
eases other than those above mentioned. 

Deafness is, to a certain extent, hereditary. The children 
of parents who became deaf late in life are liable to be like- 
wise affected after they pass middle age. 

Blindness is rarely transmitted from parents to children; 
but cases have been recorded where most members of a cer- 
tain family, for several generations, became blind after pass- 
ing their sixteenth year. 

Organic disease of the heart is sometimes the result of he- 
reditary influences. 

Bright' s disease of the kidneys is occasionally inherited 
from one or both parents. 

The predisposition to rickets is often inherited, and al- 
though the offspring of rachitic parents are not necessarily 
the subjects of the disease, yet they are more liable to suc- 
cumb to the exciting cause of rickets than those who are 
born of healthy stock; and when the disease is once devel- 
oped in them it is much more difficult to arrest than in those 
whose systems are not tainted with rachitic blood. 

Epilepsy is frequently transmitted from parent to child. 
The offspring of an epileptic parent may not have true 
epilepsy, but instead of it he may suffer from some other 
form of nervous disease having a close kinship to the pa- 
rent's affection. Likewise, if we investigate the history of a 
child that is suffering from epilepsy, not caused by an in- 
jury, we may find that neither parent was epileptic, but that 
one or both were afflicted with some form of nervous disease 



Miscellaneous Subjects. 347 

capable of being transformed into epilepsy by transmission. 
The transformation of nervous affections into one another is 
a vast subject, but imperfectly understood, and difficult of 
elucidation. 

Convulsions in children may, to some extent, be transmitted 
from mother to child— at least, observation teaches that chil- 
dren born of mothers who had convulsions before delivery 
are liable to such seizures soon after birth. 

Saint Vitus 1 dance is to a certain extent hereditary — that 
is, children who have the disease are apt to be the offspring 
of parents who have suffered from some form of nervous 
trouble, such as epilepsy, hysteria, or convulsions. 

Gout and rheumatism seem to be hereditary. Thus we 
know that the children of rheumatic and gouty parents are 
more liable to these diseases than those whose ancestors 
were free from such affections. 

No disease is more markedly hereditary than syphilis. 
The effects of the syphilitic taint may be manifested at birth 
or they may appear months afterwards. The children of 
syphilitic parents are weak and feeble, and often their various 
bodily organs are but imperfectly developed. In some cases 
the child at birth is covered by the peculiar eruption that 
belongs to syphilis. Some writers have supposed that scrof- 
ula was primarily induced by the syphilitic poison. 

Cancer is so uniformly a hereditary disease that in most 
cases we can trace its origin either to the parents or grand- 
parents; for, like consumption, it sometimes skips a genera- 
tion. 

It would seem that the transmitted taint of scrofula and 
of consumption may develop into cancer, as the children of 
tuberculous parents sometimes suffer from the latter disease. 

Intemperance acquired by those who indulge in alcoholic 
drinks sets up a predisposition or taint which may pass from 
one generation to another. Instances of an inherited ten- 



348 The Mother's Hand-Book. 

dency to drunkenness are too common to be doubted. This 
taint, however, is not lasting, like the poison of syphilis, 
consumption and scrofula, and unless kept up by intempe- 
rate habits will disappear in one or two generations. 

From the foregoing it will be seen that the laws govern- 
ing hereditary transmission of disease have a practical bear- 
ing on the marriage relation, and those who contemplate 
entering upon married life should be as careful to investi- 
gate the health and constitutional peculiarities of their in- 
tended companions as they are to inquire into their moral 
character and habits of life. 

In the management of children who have hereditary dis- 
ease transmitted to them, it is the duty of the parent to 
shield them as far as possible from any exciting cause that 
might develop the latent tendency to disease that already 
exists in their systems. Hence the offspring of those suffer- 
ing from insanity, epilepsy, or other severe nervous dis- 
orders, should be guarded as much as possible from mental 
irritation and from all habits of life calculated to call into 
action their inherited infirmity. 

Children who have inherited a tendency to consumption, 
scrofula, and like affections, should be well nourished, well 
clothed, and kept as much as possible in the open air. Those 
born of rheumatic or gouty parents should, as they grow 
older, observe the most rigid temperance and indulge but 
sparingly in animal food. 

Another practical matter that should not be overlooked is 
the propriety of avoiding matrimonial alliances between 
families possessing the same hereditary taint, as well as be- 
tween those that are related by blood, whether they possess 
the same hereditary taint or not, as there are but few fami- 
lies that are free from all congenital weaknesses and idiosyn- 
crasies, and these latter are, as we know, greatly intensified 
by marriage between those who inherit them alike. 



Miscellaneous Subjects. 349 



HEMORRHAGE. 

Hemorrhage may be arterial, venous, or of a mixed char- 
acter. In arterial hemorrhage the blood flows from an ar- 
tery, is of a bright scarlet color, and is forced out in jets. 
The size of the stream will depend upon the calibre of the 
artery that has been injured. 

In venous hemorrhage the blood is dark, and though it 
may flow in a stream of some size, it will not spurt in jets 
as in arterial hemorrhage, but the stream will be steady and 
even. If the injured vein, however, lies immediately over 
an artery, the pulsation of the latter may cause the stream 
of venous blood to flow unequally, or, in other words, each 
time the artery pulsates it will increase the force with which 
the venous blood escapes, causing a slight resemblance to an 
arterial jet. 

In slight wounds, not involving any large vessel, the 
hemorrhage will be of a mixed character; both arterial and 
venous twigs being divided, the blood will be partly arterial 
and partly venous, and have a dark red color. In such cases 
the blood will not flow in a distinct stream, but will ooze 
from the cut surface. 

Arterial hemorrhage may be dangerous to life, the danger 
depending upon the size of the vessel injured, and the diffi- 
culty of arresting the bleeding. 

Unless a very large vein is injured, venous hemorrhage 
is not dangerous, and can easily be controlled by slight pres- 
sure. 

Mixed hemorrhage is not dangerous to life, unless it oc- 
curs in a patient who is afflicted with purpura, or the " bleed- 
ing disease." 

In profuse hemorrhage the constitutional symptoms are 
well marked. As danger to life approaches, the lips and 
cheeks become pallid, there are great restlessness and anx- 



350 The Mother's Hand-Book. 

iety, the extremities are cold and bathed in a clammy per- 
spiration, the respiration is weak and sighing, the voice is 
also weak and changed in tone, the heart beats feebly and 
rapidly, the patient complains of giddiness and dimness of 
vision, and finally lapses into a state of unconsciousness. 
As soon as fainting occurs the bleeding ceases. The stop- 
page of the current of blood in the injured vessel permits 
the formation of a clot, which acts as a plug to prevent 
further bleeding. Sometimes this effort of nature is suffi- 
cient to save life. In other cases, however, no clot is formed, 
and all the alarming signs of approaching death are inten- 
sified; a slight convulsive movement ensues and the patient 
dies. Sometimes, after swooning and the formation of a clot 
in the bleeding vessel, the patient rallies, and the heart 
again forces the blood through the vessels with a force suffi- 
cient to dislodge the newly-formed clot, when the hemorrhage 
returns, to be followed by another swoon and perhaps death. 

Treatment. — In all cases of dangerous hemorrhage the pa- 
tient must not be allowed to assume the upright position. 
He must lie down with his head low, and on no account 
should he attempt to sit up, as sudden death may take place 
under such circumstances. 

The most common method of arresting bleeding is by 
pressure. In arterial hemorrhage the pressure is applied 
either at the bleeding point or on the bleeding vessel at some 
place between the wound and the heart. 

In venous, as well as in mixed, hemorrhage, the pressure 
is applied at the place where the bleeding occurs. Pressure 
at a bleeding point, if practiced as a temporary remedy, is 
usually made with a finger or the thumb pressed upon the 
part hard enough to stop the bleeding. Persons not used 
to this work usually press too hard. The pressure at first 
should be light, and gradually increased until it is sufficient 
to arrest the flow of blood. In this manner the hemorrhage 



Miscellaneous Subjects. 351 

can usually be controlled without causing much pain. Often 
the pressure made in this way is sufficient to permanently 
arrest the bleeding; but if it is not, it may be necessary to 
make a firm compress by wrapping a coin, or, what is bet- 
ter, a piece of sole leather of proper size, in a slip of muslin, 
and, applying it to the bleeding point, secure it in position 
by a firm bandage. 

Pressure on an artery above a wound may be temporarily 
made by grasping tho limb with the hand, and, placing the 
thumb over the site of the vessel, making firm pressure until 
the bleeding ceases. To succeed in this manner, however, 
the operator must have a knowledge of the course and posi- 
tion of the artery. To arrest a dangerous hemorrhage from 
an artery until surgical assistance can be obtained, the tour- 
niquet is generally used. If the operator knows where the 
artery lies he should fold a piece of muslin upon itself sev- 
eral times until he has a compress, say, two inches square 
and of sufficient thickness. This should be laid on the skin 
over the vessel; then tie a handkerchief or strong strip of 
muslin around the limb, and insert a small stick under the 
bandage and twist it until the pressure is sufficient to arrest 
the hemorrhage. The twisting of the bandage should be 
done gradually, and should cease when the bleeding stops, as 
it is not best to constrict the limb more than is necessary to 
stop the hemorrhage. 

If the operator has no knowledge of tho position of the 
injured artery, he can dispense with the use of the compress, 
and use the bandage and stick alone, which will stop the 
flow of blood, but it will require a greater constriction of the 
limb than it would if the compress were used. 

In slight wounds, where the bleeding is not free, but comes 
from minute vessels that have been divided, the application 
of^some astringent, as persulphate of iron, powdered tannin, 
alum, etc., may be of use. Such wounds should be freely 



352 The Mother's Haxd-Book. 

exposed to cold air, as sometimes the vessels will contract 
and the bleeding cease after such exposure. 

Very hot water will often arrest bleeding from small ves- 
sels. It must be used as hot as can be borne without scald- 
ing the skin; otherwise, instead of arresting the bleeding, it 
will increase it. 

In all cases of hemorrhage from the leg or arm the limb 
must be elevated above the body, the higher the better; this ex- 
pedient alone being occasionally sufficient to arrest bleeding. 

Bleeding from the palm of the hand, or about the wrist, 
if caused by injury to an artery, is always a serious matter, 
and requires prompt surgical treatment. The blood-vessels 
here are numerous and hard to tie. Until a surgeon ar- 
rives some one should take a compress and place it on the 
wound, and with the thumb make firm pressure on it, at the 
same time holding the injured hand up above the patient's 
head. If the bleeding cannot be controlled in this manner 
a compress should be laid in the bend of the elbow, and a 
handkerchief tied around the arm over it and twisted with 
a stick as before directed. Bleeding at any point below the 
elbow should be treated in the same manner. 

If the bleeding be from a wound in the arm above the 
elbow, and not too near the shoulder, the bandage should be 
placed above the bleeding point and twisted with the stick 
until the hemorrhage ceases. If the bleeding is too near 
the shoulder joint to admit of the application of the tourni- 
quet or twisted bandage above the wound, the operator 
should take a ball of yarn the size of a man's fist, or else a 
compress made by rolling a towel or similar article upon 
itself so as to make a firm roll about four inches long and 
three inches in diameter. This should be placed in the 
arm-pit as high up as possible, after which the arm should 
-be brought to the side of the chest and firmly bandaged in 
that position by passing a strong piece of muslin several 



Miscellaneous Subjects. 353 

times over the upper part of the arm and around the oppo- 
site side of the chest. If this does not arrest the Weeding, 
the operator should strip the patient's clothing from his 
breast, and placing both thumbs flat on the skin make 
steady pressure immediately above and behind the collar 
bone. The direction of the pressure should be downward 
and backward in order to compress the subclavian artery. 
In this manner bleeding can often be controlled until the 
arrival of a surgeon. 

Hemorrhage from the bottom of the foot, like that from 
the palm of the hand, is difficult to control. Pressure with 
a compress and the thumbs should be made at the bleeding 
point, and if the bleeding does not cease, a compress can be 
put in the flexure under the knee-joint and the handker- 
chief tourniquet put around the limb at that point. All 
hemorrhages below the knee are to be treated in the same 
manner. In all cases the limb must be elevated above the 
body. In hemorrhage above the knee and not too near the 
hip-joint, the handkerchief tourniquet must be applied above 
the bleeding point and tightly twisted. The blood-vessels 
here lie deep, and it requires a good deal of pressure to com- 
press them. If the bleeding cannot be controlled in this 
manner, firm pressure with the thumbs should be made 
over the femoral artery where it comes over the brim of the 
pelvis. Feel for the top of the pelvic bone at the inner part 
of the thigh, and make firm pressure against it, and the 
vessel will likely be sufficiently compressed to arrest the 
bleeding until a surgeon can be summoned. Sometimes, in 
hemorrhage from the thigh, the bleeding can be arrested by 
forcibly bending the thigh upon the body and firmly ban- 
daging the limb in that position. Likewise, bleeding from 
the foot, and the leg below the knee, may be controlled, to 
some extent, by bending the leg upon the thigh and securely 
fastening it in that position with a firm bandage. 
23 



354 The Mother's Haxd-Book. 

Bleeding from wounds about the head and face can be 
easily controlled by pressure. The bones in this situation 
are so near the surface that but little pressure with the 
thumb or finger is required to arrest the flow of blood. 

Hemorrhage from wounds of arteries in the neck is ex- 
tremely dangerous and hard to arrest. Firm pressure at the 
bleeding point should be made, and if the wound be of 
any size a compress should be placed over it and pressure 
made with the thumb or fingers, or else the wound must be 
stuffed with sponge or cotton, and pressure made upon it. 

Venous hemorrhage about the neck can be arrested by 
pressure made at the bleeding point. 

Hemorrhage from different parts of the trunk should be 
treated in the same manner as if it proceeded from wounds 
of the neck. 

The tourniquet cannot be used on the trunk, and hence 
pressure with the finger, and, if the wound be a large one, 
packing it with a sponge or bits of muslin, should be relied 
upon to control the bleeding until the arrival of a physician. 

The permanent arrest of bleeding from arteries is usually 
secured by ligatinei; the injured vessel. 



CHAPTER XXV. 



fttedictnes. 



MEDICINES should be kept in glass vials with close- 
fitting stoppers. The vials containing acids should 
have glass stoppers, but if these cannot be had one made 
of beeswax may be substituted. Cork should never be used 
to close such vials, as the acid will soon destroy it. 

Many medicines alluded to in this book are not included 
in the following list, for the reason that, being recommended 
in chronic diseases only, there will be ample time to send to 
a drug store for them. It is necessary to keep only such 
remedies in the house as may be needed for frequent use, or 
in cases of emergency. 

Vials and packages containing medicines must be care- 
fully labeled with the name of the article plainly written; 
and should the label be removed from a vial, it will be best 
to pour out the contents and refill it with the proper medi- 
cines. 

The vials containing medicines in powder should have 
large mouths to permit the easy removal of their contents. 

Some medicines lose a part of their strength by long keep- 
ing, while others, from the same cause, become stronger. 
Laudanum is an example of the latter class. It is made by 
dissolving opium in alcohol, and if a part of the alcohol 
evaporates from long keeping, the relative amount of opium 
contained in a given quantity will be increased. 

Alcohol must be kept in a bottle so tightly corked that it 
cannot evaporate. If a common cork is used it will be ne- 

[3551 



356 The Mother's Hand-Book. 

cessary to occasionally press it firmly into the bottle; other- 
wise, it will soon become loose and permit a part of the alco- 
hol to escape. 

Alcohol is a most valuable external remedy. The spirits 
of camphor and the tincture of arnica have long been highly 
prized for their healing powers. The fact is that they, as 
well as other remedies of like character, owe their virtue 
mainly to the alcohol of which they principally consist. 
Alcohol, diluted with two parts of water, is, perhaps, the best 
dressing that can be used for cuts, bruises and fresh wounds. 
A wound or laceration of soft tissues that is subjected to a 
thorough washing with dilute alcohol, and to its constant ap- 
plication afterwards, will usually heal speedily with but little 
pain and without much risk of blood-poisoning from absorp- 
tion of septic material. 

Alcohol forms the principal ingredient in certain gargles 
used in the treatment of acute sore throat, attended with in- 
flammation. 

In old sores or ulcers of a foul and indolent nature, a 
dressing of equal parts of alcohol and water can be applied 
for a few times, after which the strength should be de- 
creased by adding two or three parts of water to one of 
alcohol. 

A mixture of one part of alcohol to two or three of water 
will be sufficiently strong to apply to fresh wounds, while, as 
a gargle for an inflamed throat, the proportion should be one 
part of alcohol to four of water. 

Alum should be kept in a finely powdered state, to be used, 
if necessary, as an emetic in cases of croup. It is the least 
depressing of all the emetics, and to vomit a child with it a 
small teaspoonful, finely powdered, may be given after being 
mixed with a like quantity of honey or molasses. If the first 
dose does not produce vomiting in from ten to fifteen min- 
utes, it may be repeated with perfect safety. 



Medicines. 857 

After the child is through with vomiting it will soon re- 
cover from the nausea, and its strength will he hut little af- 
fected by the action of the medicine. 

Aromatic spirits of ammonia is a gentle stimulant and anti- 
spasmodic, and is useful in cases of fainting. It is also used 
in some forms of nervous affections as hysteria, etc. The 
dose for an adult is from a half to a teaspoonful plentifully 
diluted with water. A child one year old can take five or six 
drops in a teaspoonful of water. 

Liquor ammonia, or spirits of hartshorn, should be kept 
in a bottle with a close-fitting stopper. Mixed with equal 
parts of water it is a useful application to neutralize the 
effects of the sting of bees and other poisonous insects. Its 
principal use, however, is in preparing liniments, such as 
the common hartshorn liniment, which consists of one part 
of liquor ammonia and two of sweet oil. A liniment that 
is useful in inflammatory affections of the chest and throat 
can be made by mixing one part of the oil of cinnamon, 
four parts liquor ammonia and ten parts of sweet oil. 

Muriatic acid should be kept in a bottle with a glass stop- 
per. 

It is useful in the treatment of various eruptions on the 
body, such as ringworm, milk crust, etc. When properly 
diluted with water, it is a most valuable remedy in thrush. 

As an application to the skin in various eruptions oc- 
curring in children, the greatest care must be taken that 
it is sufficiently diluted. If the surface is very raw a tea- 
spoonful of the acid to a half pint of water can be tried, 
and if it causes much pain the mixture should be further 
diluted. 

Calomel should be kept in a dark vial to prevent exposure 
to the rays of light. If such a vial cannot be obtained, the 
light can be excluded by pasting dark paper around an or- 
dinary bottle. 



358 The Mother's Hand-Book. 

This is a very useful remedy in the hands of one who 
thoroughly understands its use; hut no non-professional per- 
son ought to presume to prescribe it internally for a child. 
It should, however, he kept in the house because of its great 
usefulness in the external treatment of eruptions and various 
diseases of the skin. Old sores or ulcers situated upon 
various parts of the body are often amenable to treatment 
by the application of calomel, either in powder or in the 
form of an ointment. 

In scald head, milk crust and other forms of eczema, ex- 
cellent results are often obtained by dressing the diseased 
surface with calomel ointment. 

It is useful also, both in the form of powder and ointment, 
in the treatment of sore navels in infants. In the vomiting 
that attends summer complaint, a minute portion (the twelfth 
of a grain) mixed with a grain of white sugar and put on 
the tongue of the child, and washed down with a teaspoon- 
ful of ice water, often gives relief. 

An ointment can be made by mixing a half teaspoonful 
of calomel with a tablespoonful of lard. If the ointment is 
to be used in warm weather, it will be best to add mutton 
tallow to the lard before mixing it with the calomel, to pre- 
vent it from melting too rapidly. When vaseline is at hand, 
it can be substituted for the lard. 

Dover's poivder is one of the most valuable and safest pre- 
parations of opium. It is given to adults in doses of from 
five to ten grains, while children one year old can take from 
a fourth to a third of a grain. It is used to procure rest and 
sleep in many forms of disease, and when combined with 
other remedies, it is of great advantage in some cases of 
diarrhoea. Containing, as it does, the same quantity of 
ipecac as of opium, it becomes one of the most valuable pre- 
parations of the latter article in the treatment of certain dis- 
eases of the chest. 



Medicines. 359 

Epsom salts should be kept in a jar with a close-fitting 
stopper. It is a valuable purgative, and is frequently used 
in domestic practice. It produces loose, watery operations, 
without much pain or griping. 

In dysentery, small doses of Epsom salts, frequently re- 
peated, is often of great value. 

The effervescent Epsom salts should be used in place of the 
old and nauseous preparation. It is not very unpleasant to 
the taste if swallowed during effervescence, and is certain 
and pleasant in its action. 

Godfrey's Cordial. — This preparation contains a small por- 
tion of opium, and is of about the same strength as paregoric. 
It is much pleasanter to the taste than the latter, and, being 
free from camphor and oil of anise, it agrees much better 
with the stomach. Twenty drops of Godfrey's Cordial is 
about equal in strength to one drop of laudanum. 

Children suffering from colic are often relieved by a few 
drops of Godfrey's Cordial when other remedies have been 
used without effect. It can be given to relieve the pain and 
straining that accompany flux in children, but care must 
be taken not to give it too often nor in too large doses. 

Godfrey's Cordial should not be administered to young 
children except in cases of absolute necessity, for, like other 
preparations containing opium, it is not only dangerous to 
some extent if improperly used, but in all cases it inter- 
rupts the process of digestion, and in this manner tends to 
increase any disorder of the stomach that may already 
exist. 

In obstinate coughs, unattended with fever or inflam- 
mation, when milder remedies afford no relief, Godfrey's 
Cordial can be beneficially added to other medicines of an 
expectorant character. As a cough remedy the dose must 
be small, not more than one-fourth of what is given to con- 
trol pain. 



360 The Mother's Hand-Book. 

For the purpose of controlling severe pain,, a child a few 
weeks old may take from ten to twelve drops of Godfrey's 
Cordial in a little water. At six months from fifteen to 
twenty drops can be given, and a child one year old can 
take from twenty-five to thirty drops. 

Glycerine is useful in chapped lips and hands and as a 
soothing application to inflamed surfaces. It enters into 
the composition of many cough medicines and mixtures for 
sore throat. 

Horse-radish. — In the form of a syrup, this article is use- 
ful in colds and coughs after the acute symptoms subside 
and the patient no longer has fever. 

A syrup can be made in the following manner: Put a 
heaping tablespoonful of fresh horse-radish, finely grated, 
into a small teacupful of alcohol and water (equal parts). 
Let it stand forty-eight hours, after which it should be 
strained through a cloth. One tablespoonful of this mix- 
ture can be added to six tablespoonfuls of a thick syrup made 
of white sugar and water. A child two years old can take 
a teaspoonful every three or four hours. 

Tincture of iodine is used as an external application in 
diseases of the throat and chest, as well as in enlargement 
of the glands, etc. In ordinary cases of ringworm of the 
face and other parts of the body, it forms a useful application. 
As a counter-irritant it can be applied once or twice a day 
until the skin becomes tender. It should not be used in 
full strength on the skin of very young children. 

Syrup of Ipecacuanha. — This is a very reliable as well as 
useful remedy, and if properly administered is entirely 
harmless. It should be kept in every house where there is 
a young child, and if promptly and judiciously used, life 
may often be saved by it. In very warm weather it should 
be kept in a cool place; otherwise, it will undergo fermenta- 
tion. 



Medicines. 361 

As an expectorant in recent colds and coughs, attended 
with fever, it is of great value. In the treatment of bron- 
chitis and in croup occurring in children, it is one of the 
most common remedies. In bronchitis it is given in small 
doses, frequently repeated. In croup it is administered in 
teaspoonful doses every ten or fifteen minutes until it pro- 
duces vomiting, after which ten to fifteen drops may be given 
every half hour to two hours to keep up its nauseating effect. 
When given as an expectorant, a child a few days old can 
take from three to five drops, while one at six months can 
take from six to ten drops at a dose. If it causes vomiting 
in these doses less should be given, the aim being to produce 
slight nausea. As an emetic, a teaspoonful will usually be 
sufficient for a child one or two years old. If the first dose 
does not produce vomiting, it can be repeated every fifteen 
minutes until it has the desired effect. The remedy is very 
safe, for if too much is given it will speedily be thrown up. 

Persulphate of iron is the most powerful astringent we pos- 
sess for arresting bleeding by direct application to the bleed- 
ing vessels. The solution of the persulphate of iron (Mon- 
sel's solution) is often used instead of the powder. Both 
articles should be kept in a vial with a closely-fitting stop- 
per. 

White lead, ground in oil, should be kept in the house, to 
be used in burns and scalds. When properly applied it is 
superior to all other dressings in these accidents. The lead 
should be kept slightly covered with linseed oil to prevent 
it from becoming hard and dry. 

Laudanum is a valuable remedy when properly prescribed, 
but in large doses it is a deadly poison. 

Persons not well acquainted with the effects of this medi- 
cine should seldom venture upon its administration, but 
cases may arise where the pain is so severe as to require a 
dose of laudanum for its mitigation. 



362 The Mother's Hand-Book. 

In that form of summer complaint known as ileo-colitis, 
it is sometimes necessary to use an injection containing a 
few drops of laudanum to relieve the severe straining and 
pain that accompany the disease. 

The dose for a young infant is from one-half to one drop. 
A child one year old can take from one to one and a half 
drops. As some children are very susceptible to the influ- 
ence of laudanum it is best to begin with a small dose. 

As the full effects of laudanum are not manifested for two 
or three hours after it has been taken, the dose should not 
be repeated inside of that time. 

Sugar of lead must be kept in a glass bottle well corked. 
As a wash, when dissolved in water, it is useful in inflamed 
conditions of the skin, especially when caused by poisonous 
substances. It is often used by non-professional persons, in 
the form of a weak solution, as an application to inflamed 
eyes, and many of the patent " eye-waters " contain sugar of 
lead. The use of such remedies in affections of the eyes is 
dangerous, for the reason that when ulcers exist upon the 
cornea, the lead is often deposited in the form of an insolu- 
ble precipitate, thus interfering with the transmission of 
light to the retina. 

Mustard, finely ground, is one of the quickest and safest 
emetics that we possess. It should be kept in a bottle 
tightly corked to exclude the air. A teaspoonful mixed with 
a half cupful of water and given to a child, when poisoned, 
will usually cause vomiting in a few seconds. The dose can 
be repeated if necessary. 

Sweet Spirits of Nitre. — An ounce or two of this medicine 
should be kept in a vial with a close-fitting cork. In small 
doses, well diluted with water, it is useful when administered 
to a child that is feverish and has a hot skin. 

The dose for an infant a few weeks old is from three to 
four drops; at six months from six to seven drops, and at 



Medicines. 303 

twelve months from ten to twelve drops. Each dose should 
he mixed with a teaspoonful of water. 

Sweet oil is often needed ahout a house, and a good-sized 
bottle filled with it should always be kept ready for use. 

A bottle of castor oil is indispensable to every family. 
Care should be taken to purchase the cold pressed oil that 
has not become stale. 

Paregoric is a useful addition to various cough mixtures 
in chronic cases where the cough depends upon irritation, 
and is not accompanied by fever. Also in some cases of colic 
in infants it may be necessary to give small doses to relieve 
pain. Twenty drops of paregoric are equal to one drop of 
laudanum in strength, and a child one year old, when suffer- 
ing from pain, can take from ten to twenty drops at a dose. 
When added to cough mixtures, or given to arrest diarrhoea, 
the dose should be from one-fourth to one-half the above 
quantity. 

Chlorate of potash should be finely powdered and kept in 
a vial tightly corked. It is useful in affections of the throat, 
and is one of the most common remedies in such cases. 

A saturated solution can be made by adding a teaspoonful 
of the potash to a small glassful of water, of which a child a 
year old may take a teaspoonful every two or three hours. 
As only a small portion is soluble in cold water, it is not 
necessary to be particular as to the amount added to the 
water for internal administration. 

As a gargle, it is useful when added to a solution of tannin 
in alcohol and water. 

Rhubarb. — This is one of the most efficient and safe laxa- 
tives used in the treatment of diseases of children. Its taste 
is the greatest objection to its use, but when properly made 
into a thick syrup children will usually lake it without diffi- 
culty. As a laxative it is of great value in diseases of chil- 
dren, for the reason that, while its primary effect is to operate 



364 The Mother's Hand-Book. 

on the bowels, its secondary effect is astringent. This being 
the case, there is but little danger of diarrhoea following the 
action of rhubarb. 

Syrup of rhubarb is usually made from the fluid extract. 
But this is not as reliable as that made directly from the 
root. The following is a good method of preparing it for 
domestic use: take a piece of Turkey* rhubarb root the size 
of a hulled walnut, cut it into very small thin pieces, and 
after putting it into a tin cup, pour over it a half pint of 
boiling water. Cover the vessel and let it stand twenty-four 
hours, after which place the mixture over a slow fire and 
let it simmer until one-third has evaporated. Strain through 
a flannel cloth, pressing the boiled rhubarb until all the 
strength is out of it. Put the fluid back into the cup, let it 
come to a boil, and add enough white sugar (about half a 
pound) to make a thick syrup. 

Of this syrup a teaspoonful can be given to a child six 
months old, while one that is a year old can take one and a 
half teaspoonfuls, and so on in proportion to age. 

If necessary, larger doses can be given with safety. If the 
first dose produces no effect within six or eight hours, its ac- 
tion may be assisted by the use of an injection of warm 
water. If this does not produce a satisfactory operation the 
rhubarb may be repeated, and if necessary it can likewise 
be followed by a similar injection. 

Tannin is another remedy that should be kept constantly 
on hand. It is a powerful astringent, and in cases of bleed- 
ing from the gums after the extraction of teeth, a small 
piece of cotton or sponge, thoroughly wet with water, and 
then dipped in the tannin until it is well saturated, can be 
placed into the cavity of the tooth and held there with firm 
pressure until the bleeding ceases. In bleeding from the 
nose, tannin, finely powdered, may be snuffed up the nostrils 
with benefit. 



Medicines. 365 

Bleeding from slight cuts also may often be arrested by 
applying tannin to the wound. 

Its use in domestic practice should be confined mostly to 
external applications and to gargles. A most useful gargle 
in all cases of sore throat, and even in diphtheria, is made 
by dissolving a teaspoonful of tannin in a tablespoonful of al- 
cohol, to which four tabiespoonfuls of water have been added. 
A child, if old enough, can gargle with this every two or three 
hours during the day. If the child is too young to use the 
gargle, the mixture should be applied to the throat by means 
of a camel's-hair brush; but if this cannot be had, the nurse 
can easily substitute a " swab " made by tying a small piece 
of well-worn muslin to a small stick or a pencil. 

The application must be made gently, so as not to irritate 
the inflamed throat by hard pressure. The addition of a 
half teaspoonful of the chlorate of potash to the above wash 
will increase its efficacy in some cases. If there is much 
white deposit in the throat the amount of tannin entering 
into the wash should be doubled. 

Vaseline constitutes a nice dressing for excoriations and 
chaps, no matter on what part of the body they are situated. 
It is an excellent substitute for lard in making ointments 
for domestic use. A tin box, containing two or three ounces 
of vaseline, should be kept in the house. 

Oxide of zinc is very useful when applied to raw surfaces, 
such as sores, excoriations, etc. The zinc should be finely 
powdered, and then {lusted on the affected parts. It is 
mainly used, however, in the form of an ointment, made by 
mixing one part of finely-powdered oxide of zinc with six 
parts of lard or vaseline. 

Precipitated carbonate of zinc is similar in its action to the 
oxide of zinc, and may be substituted for that article when, 
from any cause, the oxide is found not to answer the in- 
tended purpose. Thus, in the form of a line powder, it can 



366 The Mother's Hand-Book. 

be dusted on " chafings " and raw portions of an infant's 
skin where the moisture of the parts causes the oxide to 
form hard, irritating lumps. 

Like the oxide, it can be used in the form of an ointment 
as well as a powder. 

Sulphate of zinc, or white vitriol, is often used in inflam- 
mation of the eyes. Two grains 6f white vitriol to an 
ounce of pure rain-water forms an excellent application in 
some cases. But this, like other applications to the eyes, 
should be used only by direction of a competent physician. 
In inflammation of the skin, caused by contact with poison- 
ous substances, as poison ivy, a wash made by dissolving a 
teaspoonful of white vitriol in a pint of water constitutes a 
valuable remedy. 

Adhesive plaster will be needed in the treatment of cuts 
and for other purposes. 

It is also well to keep in the house a small roll of court 
plaster to dress wounds of the face and hands. 



APPENDIX, 

CONTAINING 

Articles on Diseases and Accidents 



THAT MAY 



SUDDENLY HAPPEN TO GROWN PERSONS. 



Pretention of 3Bi$e&$e> 



AVAST amount of sickness might be prevented by pay- 
ing proper attention to the laws of health. It is true 
that the poor and the laboring classes have not the time nor 
the means to place themselves in the best possible condition 
to enjoy healthy lives. But if possessed of a reasonable 
amount of the right kind of knowledge, anyone can, by 
using a little forethought and judgment, avoid many dis- 
eases from which the careless and negligent are sure to 
suffer. 

Many families make the mistake of living in rooms that 
are over-heated during cold weather. From 65° to 68° is as 
high a temperature as should be allowed in living rooms. 
Persons who have a tendency to disease of the lungs often 
fall victims to consumption by reason of continually breath- 
ing super-heated air. Indeed, it is possible that consump- 
tion might be avoided, even by those whoso parents were 
afflicted with the disease, by remaining constantly outdoors 
during the day-time, depending, in cold weather, upon a 
sufficient amount of clothing to keep the body warm, and 

[3^7] 



368 Appendix. 

sleeping in open rooms, without fire, at night. Such a 
course of life, however, should be begun early, before one's 
constitution has been affected to any great extent by dis- 
ease. 

Remaining for hours in a hot, close, and impure atmos- 
phere is sure to give rise to serious troubles, the effect of 
which is likely to be lasting. The practice of remaining in 
a hot room during cold weather until the body begins to per- 
spire and then going out into the cold air, often results in 
attacks of bronchitis, pneumonia or pleurisy. Persons who 
travel during the winter season in over-heated and badly 
ventilated cars are also liable to suffer from these diseases. 

Continued exposure to damp cold for hours without mak- 
ing any effort to warm the body, or to replace wet clothes by 
dry ones, is a prolific cause of diseases of an inflammatory 
or a rheumatic character. 

Sleeping in apartments that have no provision lor the ad- 
mission of fresh air is attended with great detriment to 
the general health. Even if the sleeping rooms be large, it 
is necessary that they should have ventilation in order that 
pure air may be constantly admitted, while that which has 
become foul may have means to escape. Merely raising the 
sash two or three inches and fitting a board under it will, 
in many cases, be sufficient, and will not create any current 
or draught of air in the room. 

The practice of permitting the bowels to become obsti- 
nately constipated is highly injurious. Persons who are 
habitually constipated, and who perform hard manual labor, 
thereby creating a demand for large quantities of food, are 
in great danger of incurring serious disease. When the 
bowels fail to act sufficiently often, their contents become 
highly irritating. The absorbent vessels of the intestines, 
instead of taking up the nutritive portion of the food alone, 
no doubt seize upon elements that are foreign to healthy 



Prevention of Disease. 369 

nutrition and carry them into the circulation. In this man- 
ner the blood becomes contaminated to some extent. But, 
in addition to this, the dry hardened feces, by their mere 
presence, may give rise to irritation ending in inflammation. 
Diarrhoea and dysentery are sometimes due to irritation 
caused by the presence of long-retained fecal matter in the 
bowels. 

While, as a rule, harsh purgatives ought to. be avoided, 
measures should be taken to produce a daily evacuation of 
the bowels, and if this cannot be satisfactorily accomplished 
by regulating the diet and using an occasional injection, it 
will be necessary to resort to some kind of mild purgative 
medicine. While excessive purgation should be discounte- 
nanced as being not only useless, but injurious, it is better 
and safer to take an occasional dose of a mild purgative 
than to permit the bowels to go unmoved for days at a 
time. 

There is another form of constipation that should be 
guarded against. Sometimes the bowels are moved regu- 
larly once or twice a day, but the discharges are small and 
consist of hard lumps. In such cases the intestines fail to 
empty themselves thoroughly, and the indication for an oc- 
casional mild purgative is as clearly marked as though the 
bowels were not acting at all. 

Many farmers and others engaged in hard manual labor 
make the mistake of not taking sufficient intervals of rest 
during the day's labor. To begin hard work soon after day- 
light and continue it until dark, or even later, with only an 
hour's rest at noon, will, in the end, break down the hard- 
iest constitution, and cut short by many years a natural 
life. 

Farm work ought to be conducive to long life, but as 
practiced in this country such is not the case. The average 
age to which farmers attain is not as great as that of persons 

2J. 



370 Appendix. 

engaged in some other avocations. Besides, many farmers, 
when they reach advanced life, are mere physical wrecks, 
being bent in their backs and legs to a degree that borders 
on deformity, while rheumatism, the result of previous ex- 
posure, renders them incapable of enjoying life because of 
the aches and pains from which they suffer. If they had, in 
early years, been more moderate in taxing their bodies with 
hard work, and had carefully guarded themselves against 
unnecessary exposure to bad weather, instead of being mis- 
shapen wrecks of their former selves, they would, in ad- 
vanced life, be fine specimens of matured physical man- 
hood. 

The plea made for such unremitting toil by farmers and 
others living in the country is that it is necessary, as other- 
wise they would be unable to support their families. A 
proper consideration of the subject, however, will likely 
teach the farmer that success in life depends more upon 
good management than upon hard and continuous labor. 
Instead of applying himself to unremitting bodily toil, thus 
wearing out his physical powers prematurely, he will find 
that he can get on in the world better by adopting a system 
of good management requiring an exercise of the intellec- 
tual faculties with a moderate amount of manual labor. 
Such a course will certainly tend to prolong his life, and 
most likely yield him satisfactory pecuniary results. 

The life of a farmer's Avife is usually one of hardship and 
incessant toil. Even before the dawn of day she is often 
compelled to be out of bed and at her household duties. 
Nine or ten o'clock at night finds her still at work, trying to 
complete the day's labors. Even on Sundays she has little 
or no rest, for that day in the country is often set apart for 
visiting and receiving visitors. To prepare extra meals for 
visiting friends increases the labors of the housewife and 
robs her of much needed rest and recreation. No wonder 



Prevention of Disease. 371 

that under such circumstances the good wife soon loses 
much of the ambition with which she started out in life, and 
settles down to a humdrum mode of existence that is almost 
entirely devoid of social and intellectual pleasures. She 
loses much of the charm of womanly grace that makes the 
female character lovable, and her once handsome face be- 
comes marked with those lines that tell so plainly of the 
cares, the labors, and the anxieties from which she suffers. 

Farmers' wives usually spend entirely too much of their 
time in the kitchen. Three full warm meals during every 
one of the three hundred and sixty-five days in the year are 
not necessary. Many prepare more dishes for each meal 
than is required for good living. A few articles of food, 
properly cooked, and partaken of in moderation, is sufficient 
for the enjoyment of good health. Much of the ill-health 
observed in persons who live in the country is caused by 
eating too much at a time, or else by partaking of food that 
has been badly prepared. 

The habit of eating large quantities of rich food — espe- 
cially when the system is depressed and the stomach weak- 
ened by continued hard work — so common in this country, 
will, if persisted in for any great length of time, impair the 
health of even the most vigorous. Dyspepsia, with all its 
attendant ills, will sooner or later sap the vital powers and 
cut short the existence of the victim. 

When a person is compelled to work in the harvest fields 
and other places, exposed to the direct rays of the sun, dur- 
ing the excessive heat of summer, the greatest prudence 
should be exercised both in eating and in drinking. The habit 
of drinking large draughts of very cold water at such times 
should be avoided. When thirsty the water ought to be taken 
in small quantities, a sip at a time, and swallowed slowly. 
In this manner but little cold water will be required to 
quench an ordinary thirst. Unripe and sour fruits should 



372 Appendix. 

not be indulged in under such circumstances, and green 
vegetables, such as cucumbers, melons, radishes, etc., should 
be strictly avoided; otherwise cholera morbus, diarrhoea, flux 
and similar diseases are apt to result. 

Most healthy persons eat nearly twice as much as is needed 
for sustaining their strength and providing for the repair of 
the waste tissues, and if one will remember this fact and 
confine himself to a reasonable amount of good nutritious 
food, properly prepared, he will escape many attacks of sick- 
ness that those who are less careful will be certain to incur. 

Another source of fatal disease is found in the attendance 
upon burials during inclement weather. Persons often at- 
tend such places without sufficient protection to their bodies. 
The feet are especially liable to suffer from standing upon 
cold, damp ground. During a part of the services at the 
grave the heads of those present are uncovered for quite 
awhile. As a result of such exposure, bronchitis and pneu- 
monia are to be feared, especially in those who are advanced 
in life. Those who attend burials during severe weather 
ought to protect themselves with sufficient clothing, should 
wear overshoes, and remain with their heads covered during 
the entire ceremonies. The person in charge of the ser- 
vices should, as a matter of safety, advise those present not 
to uncover their heads. 

Persons who live in malarial districts should exercise care 
in reference to their water supply. The practice of placing 
dwellings near creeks and ravines, so as to save the expense 
of constructing wells and cisterns, should be strictly avoided. 
The use of water found in springs and ravines, in malarial 
countries, for drinking and culinary purposes, is almost cer- 
tain to be followed by ague or some other form of malarial 
disease. 

If a dwelling be located upon a piece of land so elevated 
that water will readily drain from it, and if a deep well or 



Prevention of Disease. 373 

cistern be constructed to furnish water for drinking and 
other purposes, the family will escape many attacks of ma- 
larial diseases that, under other conditions, they would be 
certain to suffer from. 

If possible, persons living in malarial districts should 
sleep in upper rooms of the house. The malarial poison 
seems to.be especially active at night, and is found in low 
situations near the earth's surface. 

Those who live in houses situated in low valleys near the 
entrance of a creek or ravine are liable to suffer greatly 
from malaria, while persons living in houses in the same 
valley, but removed from intersecting creeks and hollows may 
be comparatively exempt from ague and kindred diseases. 

An even temper not only contributes to good health and 
long life, but it also adds greatly to one's enjoyment, render- 
ing him pleasant and agreeable to those with whom he is 
associated. 

Some persons are unfortunately inclined to fret and worry 
over matters that are so trivial in their nature as to be 
unworthy of serious reflection. Under such circumstances 
digestion becomes impaired, and the healthy action of the 
nervous system is interrupted. 

Of all the passions that afflict mankind, anger is, perhaps, 
the most intense and destructive in its tendencies. Under 
the influence of severe spells of anger the heart is often 
sympathetically affected, becoming intermittent in its action. 
If the trouble is long continued it may end in changes of 
the heart's structure of an incurable nature. 

Cases have been recorded by trustworthy observers of per- 
sons who, during a fit of anger, have been seized with an at- 
tack of intermittent action of the heart from which they 
never entirely recovered. 

To gain a mastery over the passions is probably within 
the power of everyone who possesses a well-balanced mind 



374 Appendix. 

coupled with a certain degree of will-power. But to insure 
success requires the persistent and long-continued exercise 
of considerable patience and self-control. But he who gives 
his best efforts to the accomplishment of this object will 
meet with an abundant reward in the better enjoyment of life, 
in the freedom from many ills that would otherwise afflict 
him, and in the addition of many years to his existence. 



CHAPTER II. 



fmn: its Significance mti treatment* 



PAIN is produced by a stimulus, stronger than usual, 
being applied to nerves of sensation, and may occur 
wherever such nerves are distributed. The stimulus, from 
whatever cause, may be applied to any part of a sensory 
nerve, from its origin to its termination; but the pain will 
be felt at its peripheral extremity. This explains why, in 
hip-joint disease, the pain, instead of being felt at the af- 
fected joint, is referred to the knee, where' no real disease 
exists. It also accounts for the well-known fact that irrita- 
tion of a nerve in the scar of an amputated limb will give 
rise to a sensation of pain that is referred to the parts that 
have been removed. 

Pain differs, in character and intensity, in different tis- 
sues, due, to some extent, to the nature of their intimate 
structure. Those tissues that are soft and easily distended 
are not the seat of such sharp, excruciating pains as are 
observed in firm and unyielding structures. 

Mucous membranes and the substance of internal organs 
are not subject to the agonizing pains that affect serous mem- 
branes which line the cavities and cover some of the viscera 
of the body. The pain that accompanies inflammation of 
the substance of the lung (pneumonia) is of a dull, heavy 
character; while in inflammation of the serous membrane 
that covers the lung (pleurisy) it is of a sharp, cutting na- 

[3751 



376 Appendix. 

ture. So, also, in inflammation of the substance of the 
brain, the pain is heavy, dull and aching; while inflamma- 
tion of its membranes gives rise to keen, lancinating pains 
that cause the patient to scream out in agony. 

Pain of the head, when of a continuous, dull, aching char- 
acter, usually depends upon some derangement of the stom- 
ach. If fixed in one spot, either on the head or the face, 
and of a sharp, darting nature, appearing in paroxysms, the 
pain is most likely neuralgic. If the pain is accompanied by 
vomiting and giddiness, it will probably prove to be an attack 
of sick or nervous headache. Nervous headache usually 
disappears in a day or two, but if the attack of pain in the 
head with vomiting and giddiness continues for a much 
longer time, it may be connected with brain disease. If the 
headache is persistent, and if, in addition to the vomiting 
and dizziness, there is squinting of the eyes, or dropping of 
the upper eye-lid, the existence of brain disease is almost 
certain. 

In the early stages of some cases of epidemic cerebro- 
spinal meningitis, the headache is intense, the patient de- 
claring that his head feels as though a saw were being driven 
through it. In such severe cases the patient usually be- 
comes delirious within a few hours from the beginning of 
the attack. During his delirium he is restless, hard to hold 
in bed, and screams, sings, or whistles in a tremulous tone. 

A pain at the top of the head indicates ovarian trouble, 
and occurs often in hysterical women. 

The pain in the head sometimes complained of by school 
children during close application to studies, may be due to 
errors of refraction of the eye, or to weakness of the mus- 
cles of accommodation, and is curable by the use of proper 
spectacles. 

Pain in the neck is Usually of rheumatic origin. When 
this is the case it will be greatly increased by any movement 



Pain: Its Significance and Treatment. 377 

of the muscles of the affected part. Neuralgic pain of the 
neck can be distinguished from the above by its paroxysmal 
character, and by its being independent of muscular move- 
ment. 

Pain in the chest may be situated in the chest wall, or in 
the interior of its cavity. In the former case it will most 
likely denote either muscular rheumatism, or intercostal 
neuralgia. If the pain is due to the former it will be greatly 
increased by any movements of the muscles of the part; if 
to the latter, the history of previous neuralgic attacks, the 
paroxysmal character of the pain, and the presence of spots 
that are tender on pressure, will be sufficient to denote its 
real nature. 

The pain that accompanies pleurisy may be referred to 
the chest wall, and as it is greatly increased when the patient 
coughs, it may be confounded with muscular rheumatism; 
but patients suffering from pleurisy have considerable fever, 
while in muscular rheumatism there is usually an absence 
of febrile movement. 

Pain in the region of the heart may arise from different 
causes. It most usually occurs in conditions of nervous de- 
bility, and is often associated with indigestion. Patients 
thus afflicted often imagine that they are the subjects of 
some serious disease of the heart, not knowing that organic 
heart disease is rarely productive of much pain, and that 
some of the worst cases are devoid of any symptoms of such 
a character as to call the attention of the patient to the true 
nature of his complaint, while functional derangements of 
the heart, depending upon nervous influences, and unat- 
tended with danger to life, cause him the greatest anxiety. 

Pain in the heart, occurring suddenly and with a feeling 
as though the heart were being tightly compressed, and ac- 
companied with intense apprehension of death, with pale- 
ness of the face and some distress in breathing, points to 



378 Appendix. 

angina pectoris, a dangerous and incurable disease. In an- 
gina pectoris the pain is usually not confined to the heart, 
but extends to the left shoulder and down the arm to the 
elbow. 

More or less pain is often felt about the heart during the 
course of acute rheumatism, and may be due to the com- 
mencement of inflammation of the membrane lining the 
cavity, or covering the outside of the heart. Permanent 
organic heart disease not infrequently has its origin in an 
attack of acute inflammatory rheumatism. 

The pains that accompany various acute affections of the 
pulmonary organs have been alluded to in the articles treat- 
ing of those diseases. 

Pain in the spinal column, increased by pressure upon any 
of the processes of the spine, usually indicates, not actual dis- 
ease of the spinal cord, but that peculiar condition of the ner- 
vous system known as spinal irritation. It is very common 
in hysterical persons, and may be present in others who from 
any cause have become greatly debilitated. 

Pain in the bach or loins is nearly always, in the absence 
of an injury, the result of muscular rheumatism, which, 
when it affects the loins, is known as lumbago. The pain is 
greatly increased by bending, straightening the back, or by 
turning in bed. The patient, if seated in a chair, finds it 
impossible to rise from it, except with the greatest difficulty 
and distress. Inflammation of the structures of the kid- 
neys, as well as the presence of stones in those organs, may 
give rise to pain in the loins; but in such cases, other symp- 
toms having reference to the urinary organs will be present, 
and besides, the patient will likely be in greater distress than 
when he is suffering merely from lumbago. In lumbago 
the pain in the loins is the only trouble complained of, while 
in affections of the kidneys other symptoms will attract at- 
tention. 



Pain: Its Significance and Treatment. 379 

Pain in the abdomen may be referred either to the abdomi- 
nal wall or to the cavity. When seated in the wall, it is 
usually either rheumatic or neuralgic. Occasionally, though 
rare, it depends upon inflammation, or abscess, situated in 
the abdominal muscles. 

When pain is referred to the contents of the abdominal 
cavity it may be dependent upon internal strangulation of 
the bowel; and when this is the case it will be accompanied 
by vomiting and constipation, with distention of the abdo- 
men. In such cases, if the vomiting continues long, the 
matters thrown up will be fecal in character and have the 
odor and appearance of discharges that are passed by stool. 

In other cases the abdominal pain may be caused by a 
hernia or rupture becoming strangulated. If a rupture is 
known to exist, and it is tender and painful on pressure, and 
if there is continuous vomiting, and especially if the vom- 
ited matters have the odor and appearance of discharges that 
are ordinarily passed from the bowels, the case is one of 
strangulated hernia, and a surgeon must be summoned with- 
out delay. 

Pain in the bowels, accompanied by swelling of the abdo- 
men and great tenderness on pressure, with a quick, weak 
pulse, is observed in cases of peritonitis — a disease, which, 
though rare, is of serious import and usually terminates 
fatally. In such cases the patient will lie on his back with 
his knees drawn up, and his face will have an anxious ex- 
pression. Closely allied to the symptoms of peritonitis, in 
some respects, are those that are observed in some hysteri- 
cal women. They complain of great pain, and cannot bear 
the least pressure upon the abdominal walls. Indeed, with 
them the slightest pressure is intolerable, while steady, firm 
pressure, if made with the patient's consent, is tolerably 
well borne. In peritonitis, the mere weight of the bed- 
clothes causes pain, while firm pressure is unbearable. 



380 Appendix. 

Pain in the abdomen, resulting from the passage of gall- 
stones from the liver into the small bowel, as well as that 
produced by a stone passing from the kidney through the 
ureter into the bladder, will be alluded to in another place. 

Pain in the hip usually denotes an affection of the sciatic 
nerve that passes downwards on the outside of the thigh. 
The disease may arise from a variety of causes, and is both 
stubborn and painful. The pain is lancinating, tearing, or 
grinding, and shoots with rapidity along the course of the 
principal nerves, sometimes to the calf, the heel or the toes. 
In sciatica the suffering is greatest at night, and when a 
paroxysm has somewhat abated, the limb feels heavy, has a 
throbbing sensation, and slight movements excite pain. 

Pains in the extremities may be due to neuralgia, in which 
case they will be sudden, sharp and lancinating, and will 
occur in paroxysms. Rheumatic pains in the limbs are con- 
tinuous, and are greatly intensified by any movement of the 
part. In acute inflammatory rheumatism the joints are the 
seat of severe pains, which are attended with redness and 
swelling of the part. In chronic rheumatism the pain is 
dull and of an aching character. 

Xon-rheumatic inflammation of the joints will give rise to 
pain differing but little, if any, from that observed in acute 
inflammatory rheumatism. The history of the patient will 
aid in making the diagnosis between the two diseases. Thus, 
in rheumatism there is usually a history of previous attacks, 
while inflammation of the .joints, not connected with rheu- 
matism, occurs as the result of direct injury, or else it is 
one of the results of a scrofulous diathesis. In the latter 
case it usually ends in a protracted affection of the bones 
and cartilages of the affected joint. 

Treatment. — Moist heat, when properly applied, is the 
most valuable of all the domestic remedies that are used 
in the alleviation of pain. The hot water bath and the ap- 



Pain: Its Significance and Treatment. 381 

plication of flannels that have been dipped in hot water, 
will be sufficient to give relief in many cases. It must be 
remembered that to be effective the water must be as hot as 
can be borne, and when flannel cloths are used they must 
be large and of considerable thickness; otherwise, the heat 
will not be sufficient to relieve the pain. In the article on 
toothache full directions have been given for applying moist 
heat by means of flannel cloths wet with hot water. 

Headache, when caused by derangement of the stomach, 
is best relieved by administering a Seidlitz powder, to which 
a teaspoonful of Epsom salts may be added. After the 
medicine has moved the bowels, a quiet sleep will generally 
restore the patient to his usual health. 

Nervous or sick headache commonly lasts a day or two in 
spite of all treatment. When the pain in the head is very 
severe, the application of hot water contained in a bladder 
or rubber bag will often give some relief. If such articles 
are not at hand, flannel cloths, dipped in hot water and 
wrung as dry as possible, can be used. When there is much 
sickness at the stomach it is best to encourage vomiting by 
giving lukewarm chamomile tea. If the patient is consti- 
pated, the bowels should be moved by means of a Seidlitz 
powder or other mild purgative. 

In the different forms of brain disease, the pain in the 
head is but little under the control of domestic remedies. 
In most cases the application to the head of a bladder or 
rubber bag, filled with hot water, will be soothing. No one 
but a physician, however, should undertake to treat a patient 
who is suffering from disease of the brain. 

The pains that accompany muscular rheumatism, wher- 
ever situated, usually yield to the application of strong 
hartshorn liniment, followed by the hot flannel cloths, which 
should be continuously applied until the patient is comfort- 
able. 



382 Appendix. 

In acute inflammatory rheumatism of the joints the local 
applications alone will not often relieve the severe pain, and 
the administration of opium, or some of its preparations, 
will sometimes be necessary to enable the patient to endure 
his sufferings. 

The pain of lumbago can usually be relieved by dry cup- 
ping the affected parts, after which large flannel cloths, wet 
with hot water, should be applied until the patient is easy. 

It is not difficult to cup the back or any other broad sur- 
face of the body. If the ordinary cupping glasses cannot 
be had, a small tumbler with smooth edges will do. The 
tumbler should be of rather thick glass, to prevent the edge 
from cutting into the skin. The parts to be cupped being 
made bare for the operation, the tumbler is held in the left 
hand and a half teaspoonful of alcohol is dropped into it; 
shake the glass and pour out the contents quickly. With a 
lighted taper set fire to the alcohol that adheres to the tum- 
bler. If the alcohol runs along the edge or mouth of the 
glass it should be quickly wiped off before the taper is ap- 
plied. The operation, to be successful, must be rapidly per- 
formed. 

If the surface to be cupped is at all level, so as to permit 
the tumbler to fit accurately at all points, no difficulty will 
be experienced in getting it to adhere closely to the parts; 
but if the surface is uneven and the bone below it thinly cov- 
ered with flesh, a large tumbler will not adhere, and a cup- 
ping glass with a small mouth must be used. After remain- 
ing in position for five or ten minutes the glass must be 
carefully removed. To do this with ease the point of a fin- 
ger can be placed on the skin just outside of the glass, and 
firm pressure made so as to permit the air to rush in under 
the edge of the glass. 

Neuralgia can often be relieved by the application of moist 
heat, applied in the manner above described; but in some 



Pain: Its Significance and Treatment. 383 

cases the pain may be so severe as to require the adminis- 
tration of some preparation of opium, in addition to the use 
of the hot-water cloths. It must be remembered, however, 
that opium should not be given in those cases where the 
symptoms indicate disease of the brain. 

The pain of pleurisy can be mitigated either by the use of 
large mustard plasters or by the hot-water cloths. Some- 
times it is best first to apply a mustard plaster and follow it 
with the hot-water applications. In very severe cases, dry 
cupping, to be followed by the hot cloths, will greatly miti- 
gate the pain. Of course, so grave a disease as pleurisy 
should always be treated by a physician. 

Pains about the region of the heart, depending upon in- 
digestion or nervous influences, and not connected with or- 
ganic disease of that organ, are properly treated by apply- 
ing large mustard plasters over the affected part. Redness 
of the skin should be kept up for quite awhile by occasion- 
ally re-applying the plasters. 

The pain that attends angina pectoris is usually of short du- 
ration, and there is but little time in which to apply reme- 
dies for its relief. Besides, the medicines used in the treat- 
ment of the disease are of a dangerous character unless 
given by those who have an intimate knowledge of their 
effects. Persons who are subject to attacks of angina pec- 
toris, if addicted to tobacco smoking, must abandon the 
habit entirely. 

Pains in the abdominal cavity, whether they proceed from 
strangulation of the bowels, or from peritonitis, or from al- 
most any other cause, should be treated by enveloping the 
whole abdomen with flannels that have been dipped into 
hot water and wrung as dry as possible. These applications 
should be renewed quite often, and if they do not give relief 
from pain, the patient should take a full dose of some pre- 
paration of opium. Twenty-five or thirty drops of laudn- 



384 Appendix. 

num can be given to a grown person, and if the pain con- 
tinues severe the dose may be repeated in two hours. 

Pains in hysterical persons can sometimes be relieved by 
hot applications to the painful part, and by the administra- 
tion of the fluid extract of valerian, or other anti-spasmodic 
medicines, which seem to relieve the nervous condition upon 
which the pains depend. Occasionally, the patient may suf- 
fer to such an extent as to require a small dose of laudanum, 
or Godfrey's Cordial, to mitigate the symptoms and produce 
rest. 

The pain in sciatica is often excruciating, and is apt to be 
long continued. The disease should always be treated by a 
physician, as the intense suffering renders it necessary to 
resort to a class of remedies in its treatment that would be 
unsafe in the hands of non-professional persons. 

Great relief, however, can often be obtained by closely 
wrapping the affected limb, from the toes up to the hip, with 
two or three folds of flannel that has been dipped in hot 
water and lightly squeezed to rid it of a part of the water. 
Over this should be placed a fold of dry flannel, or, what is 
better, a piece of oil silk, which should be neatly fastened 
around the limb. 

These applications should occasionally be renewed, so as to 
keep up the effects of the moist heat. 

Pains caused by inflammation of the joints, not due to rheu- 
matism, are best treated by hot-water dressings constantly 
applied. When matter begins to form in the parts, the 
warm-water dressings can give place to large warm poultices, 
which should be changed several times during the day and 
be kept constantly wet. 



CHAPTER III 



3Bf $£a$£s of t(te ^0Utd$. 



CHOLERA MORBUS. 

CHOLERA MORBUS usually occurs during the warm 
months of summer and in early autumn. Persons who 
have become over-heated from any cause, after a hearty in- 
dulgence in such articles of diet as are apt to produce fer- 
mentation in the stomach or bowels, are especially liable to 
an attack of the disease. 

The attack usually commences in the night a few hours 
after retiring. During the day the patient has most likely 
become over-heated from hard labor, and, being thirsty, has 
indulged in frequent and copious draughts of cold water, 
thereby weakening his digestive powers. At his evening 
meal, while in an exhausted condition, he has partaken 
freely of vegetables or fruits that are slow of digestion, or 
that quickly undergo fermentation, and during the night the 
contents of the stomach, being in a fermented condition, give 
rise to vomiting, purging and violent cramps. 

Such is the history of ordinary cases, but occasionally the 
disease is met with where the exciting cause is involved in 
some doubt. 

The attack may be preceded by slight nausea, perhaps 
diarrhoea, and a feeling of debility of one or two days' dura- 
tion. Usually, however, tho disease commences suddenly 
without previous warning. The patient awakens in tho 
• 25 [3S5I 



386 Appendix. 

night with a sense of chilliness and a disagreeable feeling 
of pressure at the pit of the stomach, which is soon followed 
by nausea and vomiting. The vomiting becomes frequent 
and persistent, and is in nearly all cases followed in a short 
time by excessive purging. Sometimes, however, the purg- 
ing may be delayed for some hours after the vomiting and 
cramps have become painful and alarming. 

At first the vomited matters consist of the ordinary con- 
tents of the stomach, but after awhile mucus mixed with 
water is thrown up. As the disease progresses, all articles 
swallowed are returned almost as soon as they reach the 
stomach. 

, The first discharges from the bowels are somewhat natu- 
ral, but they soon become thin, are of a light color, and con- 
sist of mucus mixed with water. In very severe cases they 
resemble the discharges that are seen in Asiatic cholera, 
being copious, thin, and almost without color. When first 
passed they look almost like pure water, but after standing 
awhile in a vessel a sediment forms, giving them the appear- 
ance of thin oatmeal gruel or rice water. 

If the exhaustive discharges continue in quick succes- 
sion, the body shrinks, the face becomes pinched and of a 
livid hue, the surface cold and covered with a clammy 
sweat; the hands shrivel and become wrinkled; the tongue 
and the breath are cold; the urine is either suppressed, or it 
is secreted in small quantities. 

The cramps begin in the region of the stomach, and fol- 
low an attempt at vomiting. As the disease progresses 
they extend to the muscles of the legs, the calves of which 
are affected to such an extent as to cause the patient to 
cry out with pain. In some cases the cramps extend to 
the muscles of the neck and the upper extremities. 

During the course of the disease the thirst becomes in- 
tense, the patient, if allowed to do so, taking large draughts 
of cold water, which is thrown up in a few seconds. 



Diseases of the Bowels. 887 

The above symptoms apply to cholera morbus in its most 
severe form, between which and the mildest cases, where re- 
covery takes place soon after the stomach and bowels are 
emptied, there are numerous examples of every degree of 
severity. 

Cholera morbus is rarely a fatal disease, and if epidemic 
cholera is not prevalent, the chances are that the patient 
will recover, even though the symptoms be of the gravest 
character. 

Treatment. — In the mildest cases of cholera morbus but 
little treatment is necessary. After getting rid of the irri- 
tating or indigestible food, or fermenting matters, by vomit- 
ing and purging, the patient may proceed rapidly to recover. 

In severe cases, however, prompt treatment is necessary, 
and after sending for a physician, and before his arrival, all 
that is possible should be done to relieve the patient from his 
suffering. 

The great remedy for the relief of cholera morbus is sul- 
phate of morphine, in doses of a fourth to a third of a grain 
by hypodermic injection. This, however, should be admin- 
istered by a physician only, and in his absence the patient's 
friends will content themselves with other and less hazard- 
ous measures. 

Mustard plasters, large enough to cover the whole front 
of the chest and the abdomen, should be applied and kept 
on as long as they can be well borne. At first, small quan- 
tities of ice water — a tablespoonful at a time — can be given 
to allay thirst, or small bits of ice can be swallowed for that 
purpose. If the vomiting continues, and especially if 
cramps of the stomach occur, a cupful of water, as hot as 
can be borne, should be swallowed repeatedly. If the water 
is merely warm it will do no good. To aid in relieving the 
cramps in the stomach and bowels, hot water hi large quan- 
tities, frequently injected into the bowels, will be oi' great 
service. 



388 Appendix. 

If, in spite of these measures, the patient continues to 
cramp and purge, it may be necessary to venture upon the 
administration of from thirty to thirty-five drops of lauda- 
num to a grown person. The dose, however, had better not 
be repeated before the arrival of a physician, for, although 
the patient may vomit soon after taking the laudanum, yet 
he may not throw up all of the medicine, and to repeat the 
dose under such circumstances might be injudicious and at- 
tended with danger. 

To prevent the laudanum from being thrown up, it is best 
to give it soon after the patient has had a spell of vomiting, 
and after the skin over the stomach and bowels has been 
thoroughly reddened by a mustard plaster. Nothing but 
small bits of ice or a tablespoonful of cold water should be 
given for some time after administering the laudanum; other- 
wise the medicine will not be retained. 

If laudanum, or any other preparation of opium, has been 
given, the physician must be notified of the fact as soon as he 
arrives, so that he may fully understand how to proceed in 
the future management of the case. 

Small doses of calomel, from one-eighth to one-fourth of a 
grain, mixed with white sugar and laid upon the tongue, to 
be washed down with a teaspoonful of cold water, will aid in 
arresting the vomiting and purging. If necessary the dose 
can be repeated every half hour until three or four doses are 
taken. 

When the disease passes into the cold stage, additional 
means may be necessary to restore warmth to the body and 
stimulate the heart to increased action. 

If the application of large mustard plasters, and the use 
of hot water injections have failed to restore sufficient 
warmth to the body, the next thing to do is to apply heat to 
the surface by means of bricks, or good sized rocks, well 
heated and laid on the bed beside the patient. A blanket 



Diseases of the Bowels. 389 

should be spread under and one over the patient's body, 
and upon the former can be laid bricks that have been 
heated in a fire and afterwards wrapped in wet cloths ; the up- 
per blanket must be drawn closely around the body so as to 
retain as much of the heat as possible. Care must be taken not 
to burn the patient, and to avoid this the bricks should not 
at first be placed directly against him. Several bricks should 
be used, beginning at the shoulders and extending at inter- 
vals down to the feet on each side of the body. This is the 
most effective method of applying heat during the cold 
stage of cholera morbus, and if the process be conducted 
with care and discretion, no harm need be apprehended 
from it. 

Small doses of brandy, or other spirits, given without 
dilution, will often aid materially in restoring the circula- 
tion and overcoming the extreme coldness of the surface of 
the body, but after reaction has been established such drinks 
should be discontinued. 

Convalescence is somewhat slow after severe attacks of 
cholera morbus. The patient will be weak, will suffer from 
great soreness of the muscles, and in some cases he will 
have fever for a few days. He must, therefore, remain in 
bed until his strength returns. The diet should be of the 
blandest character and of easy digestion, and be taken in 
small quantities at a time. No large draughts of water or 
other fluids should be swallowed; but the thirst may be re- 
lieved by small drinks of cold water, taken, if necessary, 
quite often. 

Dysentery, or flux, sometimes follows cholera morbus, but 
as a separate article has been given to that disease, it need 
not be treated of here. 

DIARRHOEA. 

Diarrhoea is a very common disorder, and is characterized 

by a frequent desire to go to stool and by the evacuations 



390 Appendix. 

being more liquid than the healthy discharges from the 
bowels. 

The disease may originate from different causes; irritation 
of some part of the intestinal tract being the most frequent. 
Errors in diet, either in quantity or quality, will often give 
rise to diarrhoea. The eating of unwholesome articles, such 
as animal food when approaching a putrid state; of sour, un- 
ripe fruits; or of such raw vegetables as cucumbers, melons, 
etc., may be followed by an attack of the disease. 

Diarrhoea may also follow prolonged constipation of the 
bowels. The contents of the intestines being retained 
for some time may produce a diarrhoea that is salutary, 
being nature's method of getting rid of an offending sub- 
stance. 

In irritative diarrhoea the evacuations are usually pre- 
ceded by severe griping pains, and at first consist of the 
ordinary contents of the bowels, which, however, are bad 
smelling, and soon become watery, flowing from the body in 
a stream. The discharges at first are large, but gradually 
become less in quantity. Their number varies greatly; 
in severe cases the patient may be compelled to go to stool' 
every hour or half hour throughout the day. 

Sometimes the causes that ordinarily produce irritative 
diarrhoea may be sufficient to excite inflammation of the 
mucous membrane of the bowels, constituting the inflam- 
matory form of the disease. Such cases are attended with 
fever, and the evacuations usually become smaller, more 
watery, and contain shreds of mucus mixed with the other 
ingredients. The inflammation may extend to the large 
bowel, producing flux or dysentery. 

The action of the bowels is greatly influenced by mental 
emotions. Even a chronic looseness of the bowels may be 
maintained by debility of the nervous system induced by 
worry and anxiety. 



Diseases op the Bowels. 391 

In the latter stage of Bright' s disease of the kidneys, diar- 
rhoea is often present, nature in this manner making an 
effort to rid the system of the poisonous urea which can no 
longer be eliminated by the kidneys. 

Acute diarrhoea usually terminates in recovery. Some- 
times, however, it may lapse into dysentery and end in death. 
In other cases the disease becomes chronic, constituting a 
form of diarrhoea that is extremely difficult to cure, the pa- 
tient, in the end, dying of general debility. 

All cases of chronic diarrhoea should be treated by a phy- 
sician. The lesions of the bowels in this form of the disease 
are serious, and but little inclined to yield to the curative 
action of remedies. 

The treatment of diarrhoea depends to a great extent upon 
a knowledge of its cause and the conditions present in each 
case, as well as upon its ordinary duration and termination. 
The diet must be restricted, and food and drinks should be 
given in small quantities only. Rice, arrow-root, tapioca and 
the like are useful and may be given in boiled milk, or in 
chicken or mutton broth. 

All articles that are slow of digestion, or that easily undergo 
fermentation in the stomach must be excluded. Fruits, espe- 
cially those that are acid and contain numerous small seeds 
should be avoided. 

Thirst should be allayed by giving cold water or iced tea 
in small quantities at a time. 

In acute diarrhoea the patient should rest quietly in bed 
until the severe symptoms have passed away. 

When the disease is caused by indigestible articles of diet, 
or by retained fecal matter, the purging tends to relieve the 
bowels, and should, at first, be encouraged. A dose of syrup 
of rhubarb or castor oil or Epsom salts may be given to 
clear out the intestinal canal. If pain or griping is fell with 
the operations, one or two teaspoonfuls of Godfrey's Cordial 
can be given with the purgative. 



392 Appendix. 

After the bowels have been thoroughly emptied of their 
irritating contents, rest in bed, with attention to the food and 
drink, will usually be all that the patient will require. If, 
however, the diarrhoea should continue, a dessertspoonful of 
Godfrey's Cordial, combined with a half teaspoonful of es- 
sence of ginger, can be given occasionally. 

When diarrhoea assumes an inflammatory form, as shown 
by fever and tenderness of the bowels, the abdomen should 
be covered with flannel cloths that have been wet with hot 
water. These should be frequently changed, so as to secure 
the constant effects of moist heat. At the same time small 
doses of laudanum, or some other preparation of opium, may 
be given to moderate the pain and griping sensations. As 
these cases, however, are usually protracted and somewhat 
dangerous, their management should be entrusted to a phy- 
sician. 

A diarrhoea that continues for some time after the bowels 
have been cleared of their irritating contents may require 
astringent medicines for its cure. When the discharges are 
loose and watery and not attended with much pain, and 
when they occur in a person who is weak and has lost flesh, 
and who has no fever or evidence of inflammation, such 
astringents as sugar of lead, tincture of kino or powdered 
tannin, combined with a small amount of opium or some of 
its preparations, will be of use in arresting the discharges. 
But it should be remembered that absolute rest and attention 
to the diet are the main factors in the cure of acute diarrhoea. 

The doses of medicine recommended in this article are 
intended for grown persons. 

When diarrhoea assumes the form of flux, as shown by 
the stools becoming small, painful, and attended with con- 
siderable straining — being composed of mucus, or mucus 
mixed with blood — the treatment recommended for dysen- 
tery should be commenced at once. 



Diseases of the Bowels. 393 

dysentery, or flux. 

This disease may appear in either one of two forms: first, 
catarrhal dysentery ; second, epidemic dysentery. 

The catarrhal is much the milder form of the disease, and 
may be caused by long retention of fecal matter in the lower 
bowels, or by the presence there of acrid or indigestible arti- 
cles of diet, such as unripe cherries, grapes, etc., the seeds 
and skins of which are not only indigestible, but highly irri- 
tating. 

Sudden arrest of perspiration by exposure to cold — espe- 
cially to damp cold — is sometimes the cause of the disease. 
When dysentery is caused by retention of fecal matter in 
the bowels, the result of long-continued constipation, or from 
the eating of unripe fruits, the attack may be sudden and 
without preceding fever or other manifestation of disease. 
In such cases a prompt and decided dose of castor oil com- 
bined with fifteen drops of laudanum, if the patient be an, 
adult, will usually put an end to the trouble as soon as the 
bowels have been thoroughly evacuated. Rest for a day or 
two, together with abstinence from all food, except such as 
is of a bland character, is often all that is needed to restore 
the patient to his usual health. 

If, however, a case of catarrhal dysentery be neglected, 
and no effective treatment be adopted to check it in the 
start, the disease may increase in intensity until inflamma- 
tion has developed in the large bowel, when the disease will 
be attended with fever and other symptoms of epidemic 
dysentery. 

When flux prevails as an epidemic, it is usually called 
epidemic dysentery. However, the disease may, in the begin- 
ning, assume the catarrhal form, being caused by the inges- 
tion of irritating or fermenting articles of diet, and by being 
neglected may end in inflammatory dysentery 



394 Appendix. 

The disease prevails during the late summer and early 
autumn months, when the change of temperature from night 
to day is greatest ; hence climatic influences are important 
factors in its production. 

Dysentery is especially prone to occur in malarial districts, 
owing probably to obstruction to the circulation in the liver 
induced by paroxysms of ague. In such cases the malarial 
element becomes a prominent complication, and requires the 
use of quinine in its treatment. 

Some writers conclude that the disease is caused by the 
presence of microbes or germs that are received into the 
body through the medium of the food, drink, or the air. 
Whether this be true or not, experience seems to prove that 
the discharges of the patient, if neglected and allowed to con- 
taminate the air that is breathed by a healthy person, may 
be the means of spreading the disease. The discharges un- 
dergo fermentative changes after being passed by the patient, 
and dysentery, like cholera, may be propagated to a fright- 
ful extent in this manner. 

In a majority of cases an attack of epidemic dysentery be- 
gins with a feeling of debility, loss of appetite, chilliness fol- 
lowed by feverishness, and a diarrhoea that, at first, is loose 
and free from the pain, straining, and desire to remain on 
the vessel, so characteristic of a dysenteric operation. 

In the course of one or two days from the beginning of 
the first symptoms there is a decided change in the nature 
and aspect of the discharges. They become small in quan- 
tity and consist of a yellowish white mucus resembling a 
mixture of the white and yelk of an imjDerfectly cooked egg; 
or there is an admixture of a transparent, glairy matter with 
streaks of blood; or else they may consist mainly of blood 
intimately mixed with mucus. 

The evacuations are preceded by an intense desire to be 
almost constantly on the vessel, the patient being unable to 



Diseases op the Bowels. 395 

pass more than a spoonful at a time, and that with severe pain 
and without much, if any, relief to his suffering. 

There is great pain at the lower end of the bowel, often 
extending to the bladder, and causing a frequent desire to 
pass water, which act is attended with considerable difficulty 
and suffering. 

The lower bowels are exceedingly tender upon pressure, 
and are the seat of griping or " colicky " pains. 

In severe cases, from the eighth to the fourteenth day of 
the disease, the stools may become extremely offensive and 
consist of a reddish serous liquid, in which may be seen pus 
and shreds of mortified parts of the bowel. The term 
" flesh washings " has been used to denote the character of 
such discharges. 

Vomiting often occurs during a severe attack of dysen- 
tery, and in some cases it is a serious complication, being 
frequent and persistent, thus interfering with the adminis- 
tration of remedies and the nourishment of the patient. The 
thirst is great; the tongue is either covered with a white coat 
or it is red and dry, and the patient's strength is rapidly 
exhausted. 

In fatal cases, as the disease progresses the evacuations are 
passed in bed, the patient being unable to control them. 
The face is pinched and has an anxious expression ; the 
skin is dry, harsh and wrinkled, and the pulse is small and 
feeble. 

From this condition the patient passes into a state of 
collapse. The pulse cannot be felt at the wrist ; the skin is 
covered with a cold sweat; the hands, feet, face, nose and 
ears become cold and livid; the eyes are sunken and the 
voice is husky. An obstinate hiccough distresses the pa- 
tient, whose mind usually remains clear, notwithstanding the 
severity of the symptoms. The patient may remain in this 
condition for some days before death takes place. 



396 Appendix. 

If the disease runs a favorable course the symptoms grad- 
ually subside; the intervals between the evacuations be- 
come longer; the discharges assume a brownish color and 
are more natural in character, the blood and mucus dimin- 
ishing in quantity. The pulse becomes stronger, the tongue 
grows moist and the mind clearer. Convalescence, however, 
is slow, and weeks elapse before the patient regains his 
strength. 

After the acute symptoms subside the disease may assume 
the form of chronic dysentery. In such cases the ulcers that 
have formed in the large bowel do not heal, but are kept 
constanthy irritated by the passage over them of the contents 
of the bowels, causing pain and a frequent desire to go to 
stool. The appetite is uncertain; the tongue is often smooth 
and shining; the patient is weak and emaciated, and he may 
continue in this condition for months or years, finally dying 
from exhaustion or from intercurrent disease. Sometimes, 
however, cases of chronic d} T sentery, under proper treat- 
ment, may end in complete recovery. 

During the prevalence of an epidemic of dysentery, cases 
may occur where the attack is sudden and without the pre- 
monitory symptoms heretofore alluded to. The patient is 
seized with chilliness followed by fever. The discharges 
from the very beginning are of the j>eculiar character that 
belongs to flux, being small in quantity and consisting of 
mucus or blood, or of both. There is a constant desire to go 
to stool, and the operations are attended with severe pain. 

Treatment. — The treatment of epidemic flux should in all 
cases, when possible, be conducted by a skillful physician. 
The disease is dangerous, and is attended with so much 
pain and suffering that a medical practitioner should be 
sent for without delay. Before his arrival, however, many 
things can be done to alleviate the patient's distress, and 
]30ssibly aid in his recovery. 



Diseases of the Bowels. 397 

The patient should take to his bed and remain there as 
quietly as possible. Standing, or sitting upright, tends, by 
gravitation, to produce engorgement of the blood-vessels of 
the lower bowel. Not only should the patient assume the 
recumbent position, but he should also have his hips some- 
what elevated by a pillow or other soft article being placed 
under them. 

The desire to get on a vessel must be resisted as much 
as possible, and, when the patient can no longer refrain 
from going to stool, he should sit in a vessel containing hot 
water, into which he can pass his discharges. The hot water 
will be quite soothing to the inflamed parts, and much of the 
griping and pain that attend a dysenteric operation will be 
relieved by it. Further along in the disease hot water injec- 
tions into the bowel will not only have the effect of reliev- 
ing pain, but will also aid in overcoming the inflammation 
upon which the disease depends. 

After getting back to bed, the patient should have cloths 
that have been wrung out of hot water placed over the 
lower part of his abdomen. 

If thirst is present it may be allayed by small draughts of 
cold water; and if there is sickness at the stomach, with 
vomiting, small lumps of ice can be swallowed. 

If the patient has eaten unripe fruits, or other indigesti- 
ble articles, he should, if a grown person, take a full dose of 
castor oil, to which ten drops of laudanum have been added. 
This will serve to clear out the bowels and ,g"i\ T e some relief 
to the pain. 

During the subsequent progress of the disease, when the 
discharges from the bowels are frequent and small in quan- 
tity, a teaspoonful of Epsom salts, combined with live or six 
drops of laudanum, can be given occasionally with good effect. 

If the pain continues to be severe after the above-named 
remedies have been employed, the patient, if an adult, may 



398 Appendix. 

take fifteen or twenty drops of laudanum in a teaspoonful of 
water. If necessary, this can be repeated every two or three 
hours until relief has been obtained. 

Injections of laudanum and starch water into the bowels 
have often been recommended, but they are rarely retained 
long enough to do any good, and unless administered with 
care they may be a source of positive harm. Occasional in- 
jections of considerable quantities of hot water not only afford 
material relief to the pain, but they also assist in the cure of 
the disease. 

Considerable care and skill are required in the use of in- 
jections, to avoid injuring the patient and causing him pain. 

Other remedies have been found useful in the treatment 
of flux; but as they should be prescribed by a physician 
only, they need not be mentioned here. 

The diet in this disease must be carefully attended to, 
and should be of a mild, bland character. Such articles as 
leave a large residuum after undergoing digestion must not 
be allowed. Milk, soups, gruel and rice should form the 
principal part of the patient's food. 



CHAPTER IV. 



BUioust SCidn^Bt and Wuft Colic 



BILIOUS OR HEPATIC COLIC. 

AN attack of bilious colic is caused by the passage of gall- 
stones from the liver to the small bowel*. The disease is 
rare in infancy and childhood, but after puberty it is not so 
very infrequent. 

As long as gall-stones remain quiet in the gall-bladder 
they seldom give rise to pain or any other symptom denot- 
ing their presence; but when they change their position and 
enter the cystic, or the common duct, they may cause the 
most intense suffering. 

At the commencement of a paroxysm of hepatic colic, 
pain, at first of a dull character, but soon becoming lanci- 
nating or cutting, is felt in the region of the liver. The 
intense pain, which, in nervous persons, may produce deli- 
rium and convulsions, extends from the liver to the region 
of the stomach, and in some cases to the shoulder. 

Vomiting is usually present, the food, at first, being thrown 
up, after which the matters ejected consist of water and a 
colorless mucus. 

When the attack is very violent the pulse may become 
frequent, small, and almost imperceptible; the breath lost - 
its natural warmth, and the body is bathed in a cold sweat. 
.Death, though extremely rare in this disease, may occur 
under these circumstances. 

[399] 



400 Appendix. 

In some cases of hepatic colic the patient becomes jaun- 
diced, owing to the complete closure of the duct through 
which the bile passes from the liver to the small bowel. 

The duration of an attack varies, lasting but a few hours 
in some cases, while in others- it may continue for some 
days. As soon as the gall-stones pass through the duct 
and enter the bowel the patient is relieved; the stools, which 
before had been white, become dark, and the jaundice be- 
gins to disappear. 

In the treatment of hepatic colic the hot bath is of very 
great importance. The patient should be placed in a tub 
that is deep enough to permit the water to come well up 
around his body. A blanket should be thrown over him 
and fastened around his neck. The bath must be kept as 
hot as can be borne by occasionally adding fresh supplies 
of hot water. The patient should be kept in the bath for a 
long time, or until he feels weak and faint, when he must 
immediately be removed from the water and put to bed, 
after which his abdomen should be covered with warm^ water 
cloths. These can be continued as long as the pain is severe. 

Castor oil or Epsom salts may be given, to be followed by 
injections of hot water, for the purpose of moving the 
bowels. 

If these measures are not sufficient to control the pain it 
will be necessary to resort to the use of some preparation of 
opium. If the services of a physician cannot be obtained, 
twenty-five or thirty drops of laudanum in a little water may 
be given to an adult, and if, after two hours have elapsed, 
the pain still continues severe, the dose can be repeated. 

KIDNEY OR NEPHRITIC COLIC PASSAGE OF GRAVEL FROM THE 

KIDNEY TO THE BLADDER. 

Sometimes calculi or gravel form in the kidney, the result 
of the precipitation of uric acid, or the oxalate of lime, 
around a matrix composed of mucus,, or blood corpuscles. 



Bilious, Kidney, and Wind Colic 401 

In number, size, and shape these concretions present the 
greatest diversity. In some cases a kidney may contain 
only one, while in others there may be hundreds of minute 
calculi in the organ. In size they vary from a pin's-head to 
a horse bean, and if one becomes permanently lodged in the 
pelvis of the kidney it may go on increasing in size until it 
weighs* several drachms or ounces. Such stones are liable 
to give rise to inflammation, to abscess, and to other diseases 
of the kidney. 

When a stone of some size leaves the kidney and begins 
its descent along the ureter to the bladder it produces symp- 
toms of a most marked and painful character. The patient 
is suddenly seized with intense and agonizing pain in the 
region of the kidney, accompanied with a most prostrating 
sickness and in some cases with severe cramps. The pain 
shoots down along the ureter to the bladder, the privates, 
and to the inside of the thighs. There is an incessant desire 
to make water; but the amount passed is scant, being often 
limited to a few drops at a time. The urine is high colored, 
often mixed with blood, and is voided with great pain and 
burning. The patient becomes restless; he tosses himself 
from side to side, or gets up and leans in a bent position 
against a chair or the edge of the bed. Failing to obtain 
relief in one position he tries another, only to meet with the 
same disappointment. He vomits frequently, and as the 
disease progresses his skin becomes covered with a cold 
perspiration. His agony seems to be unbearable, and it is 
questionable if any pain is more agonizing and harder to 
bear than that produced by the passage of a stone from the 
kidney to the bladder. 

If the acute symptoms continue long the patient becomes 
feverish, with a hot skin, a quick pulse, and an incessant 
thirst. 

2*> 



402 Appendix, 

After these symptoms have continued for an uncertain 
period — it may be a few hours or it may be days — the pa- 
tient experiences sudden relief. The stone passes out of the 
ureter into the bladder and the suffering is at an end. 

In rare cases the stone may not pass entirely through the 
ureter, but be arrested at some point in its course. When 
this occurs the relief will not be complete, for, although the 
symptoms are modified, they do not entirely subside, and if 
both ureters become entirely closed by the presence of 
stones, death rapidly takes place. This condition, however, 
is of very rare occurrence. 

The treatment of paroxysms of nephritic colic is similar 
to that recommended for the relief of hepatic colic. The 
hot water bath, to be followed by hot water cloths, and in 
severe cases the administration of some preparation of 
opium, are the principal means of affording relief. Some- 
times the pain is so severe and long continued as to compel 
the physician to administer chloroform for its relief. 

Moist heat, when long continued, has the effect of sub- 
duing muscular spasm, thus permitting the ureter to dilate 
sufficiently to enable the stone to pass into the bladder. 

INTESTINAL OR WIND COLIC. 

This disease consists of painful and irregular contractions 
of the muscular fibres of the intestines, and is not accompa- 
nied with fever. 

The principal cause is irritation of the bowels from accu- 
mulation of gas due to fermentation of undigested food and 
the decomposition of fecal matter that has long been retained 
in the large intestine. 

The eating of certain articles of indigestible food, the pre- 
sence of worms in the intestines, as well as various other 
causes of irritation of the intestinal tract, may give rise to 
the disorder. 



Bilious, Kidney, and Wind Colic. 403 

The characteristic symptom of intestinal colic is irregular 
or paroxysmal pain situated in the abdomen and beginning 
at, or near, the navel, and spreading thence to other parts or 
perhaps to the whole abdomen. 

The duration of the disease varies greatly; the attack last- 
ing but a few minutes in some cases, while in others it may 
continue for many hours, leaving the patient with great sore- 
ness in the abdomen. 

Colic usually ends in recovery after a free evacuation 
from the bowels. Sometimes, however, the trouble is caused 
by strangulation or twisting of the bowel, and when this is 
the case fatal peritonitis is likely to occur within a few days 
from the commencement of the attack. 

The treatment consists in first securing a thorough evacua- 
tion of the bowels. This can be done by giving a full dose 
of Epsom salts or castor oil to which a small amount of God- 
frey's Cordial has been added. At the same time injections 
of large quantities of hot water should be used frequently 
until the bowels have been thoroughly emptied. When the 
pain is excessive the hot water bath should be resorted to, 
and afterwards hot water cloths should be applied over the 
whole of the abdomen. A mixture of turpentine and lard 
can be briskly rubbed over the abdomen each time the hot 
water cloths are renewed. 

Internally the patient can take a few drops of the essence 
of peppermint that has been dropped on a lump of sugar. 
Sometimes drinking a large glass of very hot water will af- 
ford great relief. 

In very severe cases it may be necessary to administer 
some preparation of opium to relieve the agonizing pain 
and cramps, but as stubborn cases of this kind often depend 
upon some serious lesion in the bowels it is safest, under 
such circumstances, to secure the services of a, physician 
without delay. 



CHAPTER V. 



SlisceUmteoits 3Bi$£&$£§< 



FAINTING, OR SYNCOPE. 

FAINTING may be induced by sudden failure of the heart's 
action from any cause. 

The liability to syncope varies greatly in different per- 
sons, some being almost proof against it, while others faint 
from the slightest possible cause. 

The trouble occurs most frequently in nervous persons, 
and may be due to a variety of causes, such as the emotions 
of fear, grief, joy, etc. The sight of blood readily produces 
fainting in some persons. Injuries of the great nervous 
centres, as in concussion of the brain, will give rise to the 
trouble. Sometimes irritation of the stomach, bowels, womb 
and other organs, produce fainting through reflex action of 
the nervous system. The loss of a large amount of blood, 
as in hemorrhage during labor, is often followed by fainting, 
which in some patients soon ends in death. Confinement in 
a hot, impure atmosphere, as well as remaining too long 
in a hot bath, will, in many persons, induce fainting. 

A person about to faint becomes pale, staggers, or leans 
against the nearest support; the eyes roll upward, while the 
lids close, and consciousness is impaired. The respiration is 
irregular and feeble; the pulse is weak, frequent and irregu- 
lar. In a short time consciousness is completely lost and 
the patient falls. The surface of the body is pale and pos- 
sibly cold; the eyes are closed and the pupils dilated; the 

[4 4] 



Miscellaneous Diseases. 405 

breathing cannot be distinguished, or else it occurs as occa- 
sional weak sighs. 

In cases of fainting from loss of blood there may be rest- 
lessness and delirium, followed by convulsions. 

Recovery from fainting is marked by gradually returning 
consciousness, by an increase of the pulse at the wrist, and 
by the re-appearance of the respiration. At first there is a 
slight movement of the hands and head with deep sighing. 
Color returns to the face and lips, and warmth to the ex- 
tremities, while consciousness is gradually restored. 

An attack of fainting varies from a few moments to an 
hour or more in duration, and may be followed in a short 
time by others of the same character. 

The usual termination of syncope is in recovery; but 
when it arises from loss of blood or from organic diseases of 
the heart, it may be fatal. 

If it be associated with hysteria in a highly nervous 
woman, the liability to syncope may last for months, or even 
years. 

In the treatment of fainting two indications are to be met, 
namely, removal of the cause of faintness and restoration of 
the heart's action. 

If a person faints, but has not fallen, he must be caught 
and laid flat on his back. Air must be freely admitted to 
him either by throwing open the doors and windows, or by 
taking him out into the open air. The dress should be loos- 
ened about the neck and abdomen. If ho is bleeding, means 
must be adopted to stop it, while his head is placed lower 
than his body. If the patient be in a room it must be 
cleared of all persons except those who are engaged in wait- 
ing upon him. If he is in the open air the crowd must be 
kept at a distance from him. 

Brandy, or other spirits, cither pure or in water, should be 
given if the patient can swallow. Smelling salts or spirits 



406 Appendix. 

of hartshorn can be held near the nose for the purpose of 
exciting the heart renexly through the nervous centres. If 
the ability to swallow is lost it may be necessary to use injec- 
tions of brandy or other strong stimulants. 

When the patient begins to rally, a teaspoonful of the 
aromatic spirits of ammonia, in a half wineglassful of water, 
can be given every fifteen or twenty minutes until reaction 
has been fully established. 

After reaction has taken place the patient should remain 
at rest in bed for some time, and before assuming the upright 
position he should partake of some nourishment if it can be 
borne. 

SUNSTROKE. 

Sunstroke is caused by the influence of excessive heat 
upon the human body, and may be divided into three distinct 
forms; first, simple exhaustion from heat; second, heat fever, 
or true sunstroke; and third, inflammation of the membranes 
of the brain, which is very rare and need not be treated of in 
this article. 

Owing to a variety of causes some persons are more easily 
affected by heat than others. Inability to withstand high 
degrees of heat may be owing to constitutional causes, but 
more often it is due to certain habits of life. Thus, those 
who are addicted to the habitual consumption of beer and 
alcoholic drinks are more liable to the disease than those 
who are free from such indulgences. 

Excessive fatigue from hard manual labor renders one li- 
able to sunstroke under conditions favorable to its develop- 
ment. Exposure to the direct rays of the sun is the com- 
mon exciting cause of the disease, but it may occur as the 
result of being confined in over-heated and over-crowded 
rooms without proper ventilation. 

In the simple form, or heat exhaustion with fainting, the 
surface of the body is pale, cool and moist; the pulse is quick 
and feeble, and the respirations are short and hurried. 



Miscellaneous Diseases. 407 

In the beginning of the attack the sight becomes dim, the 
ears are affected with peculiar rushing sounds, and the pa- 
tient sinks down in an unconscious condition. Usually in 
a few hours, under proper treatment, the symptoms subside 
and the patient speedily recovers. 

In the second form (true sunstroke) the patient complains 
of frontal headache, is weak, and often has nausea, some- 
times vomiting, and is troubled with giddiness. These 
symptoms may be followed in a short time by sudden loss of 
consciousness, the patient falling to the ground in a helpless 
condition. The surface of the body is flushed or somewhat 
livid in hue, the eyes are red and the pupils most usually 
contracted. The breathing is rapid, noisy, and labored, and 
often accompanied with a purring or blowing sound during ex- 
piration. The skin is dry and hot, while the pulse is quick 
and sometimes feeble. Convulsions may occur, and the 
contents of the bowels and bladder are usually passed un- 
consciously. 

The most severe cases of sunstroke may end fatally within 
a few minutes. 

In favorable cases, when recovery is about to take place, 
the surface of the body becomes cooler and more natural in 
appearance; the breathing is deeper and less labored; the 
pulse is slower and more distinct; the patient becomes rest- 
less and consciousness gradually returns. 

The treatment of sunstroke varies with the form of the dis- 
ease. Thus in mild cases the patient should be laid on his 
back with his head low. Plenty of air should be admitted 
into the room, and persons must not be permitted to crowd 
around the bed. 

If the patient can swallow, a teaspoonful of the aromatic 
spirits of ammonia in a half wineglassful of water can bo given 
every quarter or half hour until reaction sots in. If the 
spirits of ammonia is not at hand, whiskey and water may bo 



408 Appendix. 

given occasionally while the symptoms of prostration are 
present. If the patient cannot swallow, an injection consist- 
ing of a half teacupful of whiskey and as much water, to 
which forty drops of laudanum have been added, should be 
thrown into the bowel. 

In the severe form of sunstroke, when the skin is hot 
and dry and there is a high grade of fever, cold water 
should be freely applied to the surface of the body by means 
of the sponge bath or the wet sheet. The cold water appli- 
cations must not be continued too long, however, and if, 
after using them for a reasonable time, there seems to be no 
improvement in the patient's condition, it will be safer to use 
the water at a temperature of about blood heat. 

As the fever subsides, if there is great exhaustion, as 
is shown by a weak pulse and feeble respiration, the vital 
organs should be stimulated by administering aromatic 
spirits of ammonia, or, if that cannot be had, by small doses 
of whiskey diluted with water. 

In all cases after recovery from sunstroke the patient 
should, for some days, be kept at rest, and exposure to 
fatigue and excessive heat must be guarded against. 

HAEMOPTYSIS, OR BLEEDING FROM THE LUNGS. 

Haemoptysis is, in nearly all cases, caused by some organic 
disease situated either in the lungs or in the heart. It so 
often depends upon consumption and so seldom upon other 
affections that its presence is regarded as evidence of a 
phthisical affection. Bleeding from the lungs may also be 
caused by obstructive disease of the heart, and in some fe- 
males it may follow upon suppression of menstruation. 

Symptoms. — Preceding an attack of haemoptysis there is 
usually a sense of heat and oppression in the chest; and 
sometimes headache, vertigo, and palpitation of the heart 
are present. The quantity of blood brought up varies 



Miscellaneous Diseases. 409 

greatly in different cases. Sometimes it is a mere streak, 
while at others a pint or a quart may be lost. 

In severe hemorrhages from the lungs the blood is usually 
of a bright red color, and to some extent mixed with air. 
Occasionally, however, it will be dark and clotted. In other 
cases the quantity may be small and consist of streaks of a 
bright color. Sometimes large mouthfuls of red blood, plen- 
tifully mixed with air, are expectorated. 

In favorable cases, after the hemorrhages cease, the patient 
continues to expectorate clots of dark blood, mixed with 
mucus, for several days. Sometimes the clots of coagulated 
blood lodge in one of the large bronchial tubes, producing 
considerable distress in breathing until the clot is discharged 
by coughing. 

Bleeding from the lungs nearly always produces a great 
shock to the system, the patient being anxious and alarmed 
for his safety, especially during the first attack. 

At first the temperature is depressed, afterwards it becomes 
normal, and in cases where the bleeding occurs in persons 
suffering from consumption it soon rises above a healthy 
standard. 

The duration of the disease is variable. Sometimes but a 
trifling amount of blood i-s lost and the trouble is ended in 
a few hours. In other cases the bleeding may continue, at 
intervals, for several weeks, producing such debility that the 
patient is a long time in recovering his usual strength. 

Haemoptysis is known by the loose cough, the gurgling 
sound in the bronchial tubes, and by the repeated expecto- 
ration of bright, frothy blood. If one of the large vessels 
of the lungs containing venous blood gives way, the hemor- 
rhage will be copious and consist of dark blood. This, how- 
ever, rarely happens. 

Ulceration of the throat, by involving a vessel in the ton- 
sil, or the pharynx, may produce a hemorrhage that is liable 



410 Appendix. 

to be mistaken for haemoptysis. A careful inspection of the 
throat and gums in all suspected cases will suffice to clear 
up any doubts that may exist as to the source of the bleed- 
ing. 

Treatment. — After sending for medical assistance in all 
severe cases, the patient should be put to bed and abso- 
lute rest insisted upon. . He must not be permitted to talk, 
but should make his wants known by signs, or by writing. 
His room must be kept quiet, cool and well ventilated. Fresh 
air should be admitted freely into the room, but no currents 
must be permitted to pass near the patient's bed. The bed 
clothes should be light, but of sufficient quantity to be com- 
fortable. Heat should be applied to the feet, either by means 
of bottles of hot water, or by hot bricks enveloped in cloths. 
In severe cases, -small lumps of ice, contained in a bladder 
or flannel sack, can be applied for a few moments to the 
chest as near the bleeding point as possible. The ice blad- 
der should be kept on the chest but a few moments at a 
time. If, however, the hemorrhage continues, it can be 
re-applied frequently. If proper care be taken, there is no 
danger of causing the patient to take cold by its use. 

Assuring him that his attack is not dangerous to life is 
beneficial to the sufferer by reason of the soothing effect 
that such assurance exerts upon his mind. 

Table salt is a popular domestic remedy in common use; 
but it should not be depended upon, as it is greatly inferior 
to other remedies in controlling hemorrhage. 

The fluid extract of ergot, in doses of thirty drops, in a 
tablespoonful of water, to which the half of a rounded tea- 
spoonful of gallic acid has been added, will be of great 
service in controlling the bleeding. The ergot and gallic acid 
can be repeated, if necessary, every hour or two until five or 
six doses have been taken. As the hemorrhage subsides the 
intervals between the doses can be lengthened. 



Miscellaneous Diseases. 411 

The diet must be restricted to cold nutritious articles of a 
fluid or semi-solid nature. Stimulants, except in special 
cases, should not be administered, and thirst can be allayed 
by cold water given in small quantities. 

ILEMETAMESIS, OR VOMITING OF BLOOD. 

Vomiting of blood may be due to the laying open of an 
artery in the stomach, to congestion of the veins or capillary 
vessels of the gastric mucous membrane, or to disease of the 
blood, rendering it liable to transude through the vessels of 
the stomach under pressure of the circulation. 

Chronic ulcer of the stomach, involving an artery, is the 
most frequent cause of gastric hemorrhage. In such cases 
the bleeding usually occurs soon after a meal, the quantity 
of blood lost varying greatly in different cases. It may be very 
trifling in amount, or it may be so great as to imperil life. 

Cancer of the stomach is rarely accompanied by much 
bleeding, and when hemorrhage does occur it is in the form 
of slight oozing; and as the blood remains in the stomach 
for some time, being acted upon by the gastric juice, it be- 
comes dark in color, and when thrown up constitutes the 
"coffee-ground" vomit so often present in gastric cancer^ 
Vomiting does not always follow bleeding into the stomach, 
for instead of being ejected in the usual way the blood some- 
times passes off by the bowels. In nearly all cases of gastric 
hemorrhage some of the blood finds its way into the bowels 
and is passed by stool. This may happen in a short time after 
the hemorrhage has taken place, or it may be two or three 
days before it passes out of the body in this manner. In 
such cases the blood, when passed by stool, will be dark and 
often of a pitchy character. 

When red blood is vomited it is evidence that the hem- 
orrhage is of recent occurrence, and the blood is most likely 
still being poured out into the stomach. When the vomit is 



412 Appendix. 

dark and consists of coagula or clots, we infer that it has re- 
mained some little while in the stomach, and that the hem- 
orrhage may have temporarily ceased. 

Females of weakly habit — especially those who are pre- 
disposed to consumption-r-sometimes suffer from vomiting 
of blood as the result of suppression of their monthly periods. 

Symptoms. — When a cojDious hemorrhage into the stomach 
occurs, the patient complains of faintness accompanied with 
a feeling of weight at the pit of the stomach. The counte- 
nance is pale; the pulse is weak, and actual fainting may 
happen. Vomiting usually takes place in a short time, the 
amount and character of the blood thrown up varying with 
the severity of the case. If the hemorrhage into the 
stomach be sudden and profuse, the blood vomited will be 
red and fluid; but if the bleeding has been going on for 
some time, and in small quantities, the vomited blood will 
be of a dark color and contain coagula or clots. 

The hemorrhage may cease soon after the stomach has 
been emptied, or it may recur at frequent intervals for an in- 
definite period. 

Occasionally it is somewhat difficult to distinguish be- 
tween hemorrhage from the stomach and from the lungs. 
In the former case the blood is brought up by vomiting; in 
the latter by coughing. In hemorrhage from the stomach 
the blood contains no " air bubbles," though in some cases 
it may be red. Usually, however, it is of a dark color, and 
is mixed with small particles of undigested food. In hem- 
orrhage from the lungs the blood is of a bright scarlet 
color, is frothy, and contains mucus. After standing awhile 
it coagulates, and the clots thus formed, on being pressed 
upon, are found to contain air, which escapes with a slight 
noise. 

Hemorrhage into the stomach is not usually fatal of itself. 
When death occurs it is ordinarily owing to the disease that 



Miscellaneous Diseases. 413 

gave rise to the hemorrhage. Occasionally, however, death 
speedily follows an attack of vomiting of blood. This is apt 
to be the case when a large artery has been opened, or when 
an aneurism has bursted and poured out its contents into 
the stomach. 

Treatment. — When large quantities of blood have been 
thrown up from the stomach no time should be wasted on 
dilatory measures; but prompt and energetic treatment 
should be instituted. If a doctor be near he should be 
summoned, but if he cannot be had the following direc- 
tions should be followed: the patient should lie quietly in 
bed with his head on a level with his body. The room 
should be well ventilated, good, fresh air being necessary to 
his welfare. Visitors should be excluded from his room. 
No food must be given, but if the patient is thirsty he may 
have small lumps of ice to suck in case of faintness. It is 
best not to give brandy, or other stimulants, by the mouth, 
but a half-teacupful of whiskey may be injected into the 
bowel. Spirits of hartshorn should be held to the nose, 
while the face and forehead can be bathed with cold water. 
Ice, if it be at hand, should be enclosed in a bladder, or 
flannel sack, and laid over the stomach, 

If the amount of blood vomited be small, gallic acid — half 
a teaspoonful at a dose — -can be given to a grown person. It 
may be dissolved in a little warm water, or, what is better, 
enclosed in a capsule and swallowed with cold water. If the 
hemorrhage continues, the gallic acid may be given every 
quarter or half hour, until eight or ten doses have been 
taken, unless it produces sickness at the stomach, in which 
case it should bo withheld for awhile. If this treatment, after 
having been tried for a reasonable time, fails to arrest the 
bleeding, or if the hemorrhage at anytime becomes profuse 
and no physician be present, recourse must be had to 3 1 ou- 
sel's solution of the pcr-sulphate of iron. The usual dose of 



414 Appendix. 

this medicine is from five to ten drops given in a half wine- 
glassful of water; but in cases of hemorrhage into the stom- 
ach attended with great danger to life, I have administered 
it in much larger doses. A small teaspoonful mixed with a 
wineglassful of water can be given with safety; but usually 
one-half that quantity mixed with a half wineglassful of 
water will be sufficient to arrest the bleeding. 

In dangerous cases, when the hemorrhage continues, the 
iron can be repeated at intervals from a half hour to an hour 
apart. This remedy should be given only in cases attended 
with danger to life. 

For several days after the arrest of the bleeding, the food 
must be of the blandest nature and given in small quanti- 
ties. Warm drinks, as well as warm food, must be avoided, 
and the patient should be kept at rest, avoiding as much 
as possible, all sources of anxiety and worry. The bowels 
should be attended to, and if they do not act naturally, an 
injection of warm water and castor oil can be given with a 
view of removing the decomposed blood and other contents. 



INDEX. 



383 

27 



Page. 
Abdomen, pain in, during pregnancy, . . 22 

pain in, from various causes, .... 

Abortion, or miscarriage, 

Abscess of the breast • • • • 49 

Acid carbolic, as a disinfectant, 342 

Acid muriatic, uses of, 357 

Acids, poisoning by, 317 

Accidents from gunpowder, 306 

from lightning, ."329 

Adhesive plaster, '.366 

After-birth, delivery of, % 41 

Ague, or intermittent fever, ."218 

how to avoid, 372 

Air-passages, foreign bodies in the, .... 326 

Alcohol, uses of, 355 

Alum, uses of, 356 

Ammonia, spirits of, 357 

Anger, effects of, 373 

Angina pectoris, or neuralgia of the heart, 383 

Aromatic spirits of ammonia, 357 

Aqua fortis, poisoning by 317 

Arsenic, poisoning by, 319 

Artificial feeding, 103 

Attention to child after birth,'. 54 

Back, pain in the, "\ ..-..._.-. ... . . . 378 

Barley water, how to prepare" 106 

Bathing ' 121 

Belladonna, poisoning by, 318 

Bilious colic, 399 

treatment of, 400 

Bleeding from accidents, 349 

from the lungs 408 

from the navel, 66 

from the nose, 335 

from the stomach 411 

after extracting teeth 364 

Blood, spitting of, 408 

in the stools, 411 

vomiting of, 411 

Blows on the head 310 

Blue disease, or cyanosis, 55 

Bow-legs, 73 

Bowel, closure of the, 72 

protrusion of the, 200 

I? 



PAGE. 

Bowels, constipation of, in new born, ... 64 

A constipation of, in adults 368 

constipation of, during pregnancy. . . 16 

inflammation of (see peritonitis), ... 193 

obstruction of, in wind colic, 403 

Bowels, diseases of, 191-202 

Brain, pain in inflammation of the, .... 381 

tubercular disease of the 230 

Breasts, abscess of the, 49 

during pregnancy, 15 

inflammation of the, in new-born chil- 
dren, 64 

Bruises and their treatment, 309 

Bronchitis, 177 

capillary, '. V 178 

treatment of bronchitis, 179 

Broncho-pneumonia 179 

Burns, 299 

treatment of, 301 

Burials, diseases contracted at, 372 

Calomel, uses of, r 357 

Camphor, poisoning by, 318 

Carbolic acid, a disinfectant, 342 

Castor oil, how to administer, 16 

uses of, 363 

Catarrh, acute, 165 

of air-passages, during teething, . . 90-93 

Catarrhal fever, or bronchitis 177 

Cerebro-spinal meningitis, 238 

treatment of, 240 

Chafings, in the new-born, 66 

Chicken-pox, 297 

Child, attention to the, after birth, .... 54 
influence of mother's life on the, dur- 
ing pregnancy, 11 

early application of the, to the breast, 59 

washing the, 56 

Children, hygiene of, 115 

kindness to, 115 

still-born 52-61 

suffocation of, in bed, 69 

Chlorate of potash, uses of, 363 

Chloride of lime as a disinfectant, .... S42 

Choking, 329 

si 



416 



Index. 



Cholera infantum 202 

treatment of, 208 

Cholera morbus, 385 

treatment of, 387 

Chorea, or St. Vitus' dance, 232 

treatment of, 234 

Club-foot 72 

Colds, or catarrh 165 

Colic in children, 79 

bilious, or hepatic 399 

intestinal, or wind 402 

kidney, or nephritic, 400 

Condensed milk, how to prepare, 104 

Confinement, 32 

nurse's duties in 33-39 

preparations for 32 

Constipation of the bowels in adults, ... 368 

during pregnancy, 16 

in children, 64, 192 

Consultations, not often necessary, .... 136 

Consumption, 244 

treatment of, 247 

Convulsions, 230 

treatment of, 231 

signs of approaching, 150 

Coryza 106 

Cough, 169 

Cough, whooping, 274 

Copperas as a disinfectant, 342 

Cord, dressing the, 57 

tying the, 55 

ulceration of the, 65 

Corrosive sublimate, poisoning by 318 

Cramps in cholera morbus, 386 

during pregnancy, . . 22 

Croup, spasmodic or false, 172 

treatment of, 173 

true or membranous, 174 

treatment of, 175 

Cupping, how to perform the operation 

of, 382 

Dandruff, 261 

Deformities in the new-born, 70 

in rickets, 255 

Dentition, or teething, 86 

Diarrhoea in adults, 390 

treatment of, ... . = 391 

during pregnancy, 17 

simple, in children, 194 

as a form of summer complaint, ... 207 

Diphtheria, 279 

treatment of, 282 

Disease, prevention of, 367 

signs and symptoms of, 145 

Disinfectants 340 



Dislocations, 308 

Dover's powder, uses of, 358 

Dress in infancy, 126 

in childhood, 128 

during pregnancy, 14 

Dropsy after scarlet fever, 289 

Drowning 314 

Dwelling, the, 117 

Dysentery, or flux, 393 

treatment of, 396 

Ear, foreign bodies in the, 324 

Earache, 90, 336 

Ears, sore, 312 

Eating, excessive, a cause of disease, . . . 371 

Eczema, 265 

treatment of, 268 

Emergencies, what to do in cases of, . . . 138 

Empyema, a complication of pleurisy, . . 185 

Enlargement of the tonsils, 160 

Ephemeral fever, 216 

Epilepsy often an inherited disease, ... 346 

Eruptive diseases,. 259 

Eruptions during dentition, 90-93 

Erysipelas . . 83 

treatment of. 85 

Exercise, 128-130 

Excoriations in summer complaint, ... 214 

Eyes, film growing over the 73 

foreign bodies in the 325 

inflammation of the 65-77 

lime in the, . 312 

Fainting, 404 

Feeding, 96 

Fever, catarrhal, 177 

ephemeral, 216 

intermittent, = ... 218 

remittent or typhoid, 222 

scarlet, 285 

spotted, 238 

Fever blisters, 265 

Flooding, during confinement, ....... 40 

during pregnancy, 25 

Flour-ball, how to prepare, 107 

Flux, or dysentery 393 

treatment of, 396 

Food, kind to give at weaning Ill 

Foods, infant, how to prepare 105 

Foreign bodies in the air-passages, .... 326 

in the ear, 324 

in the eye, 325 

in the nose, 328 

Fracture of bones „ 308 

Frost-bite, 311 

Fumigation after contagious diseases, . . 343 



Index. 



417 



Gallstones in the liver, 399 

Gelatine, how to prepare 106 

German measles, 295 

treatment of, 297 

Gravel in the kidneys, 400 

Gums, how to lance the, 94 

Gunpowder, injuries from, 306 

BLemetamesis, or vomiting blood 411 

treatment of, 413 

Haemoptysis, or bleeding from the lungs, , 408 

treatment of, 410 

Harelip, 71 

Hartshorn, poisoning by 317 

Head, injuries of the 310 

pain in the, 376 

swellings on the, 64 

Headache, nervous, 881 

Health, deviations from, during pregnancy, 15 

Heartburn, during pregnancy, 17 

Heart, pain in the 377-383 

Heat, prickly, 259 

Hemorrhage, from accidents, 349 

during confinement, 40 

during pregnancy 25 

Hepatic colic, 399 

Heredity, . 344 

Hernia, or rupture in lnfant9, 75 

Hiccough, 196, 241 

Horse-radish, uses of, 360 

Hooping cough (see whooping cough), . . 274 

Hot cloths, how to appiy 20 

Hot water in cholera morbus 387 

in pain 380 

in various forms of colic, . . . 400, 402-403 

Hygiene of children, 115 

Hysteria, treatment of pain in, 384 

Ileo-colitis, a form of summer complaint, 205 

treatment of, 212 

Incontinence of urine 337 

Infants, premature 67 

Infant foods, how to prepare, 105 

Infantile remittent fever, 222 

treatment of, 227 

Injuries from gunpowder, 306 

from lightning, 329 

Insects, poisonous, 322 

Intermittent fever 218 

treatment of, 221 

Intestinal colic, 402 

treatment of, 403 

Iodine, tincture of, 360 

Ipecacuanha, uses of 360 

Itch, 259 

Itching, during pregnancy 21 

Ivy, poisoning by, 821 

27 



Jaundice-, 66-75 

Joints, inflammation of the, 384 

rheumatism of the, 382-384 

Jimson weed, poisoning by, 319 

Kidney colic, 400 

Kindness to children, 115 

Labor, or confinement, 32 

symptoms of approaching, 34 

management of, 87 

hemorrhage during, 40 

nurse's duties in, 33-39 

delivery of the after -birth, 41 

Lacto-Preparata as an infant food 104 

Laryngismus stridulus, or child crowing, . 235 

Laryngitis, membranous (see true croup), 174 

spasmodic (see false croup), 172 

Laudanum, poisoning by, 320 

uses of, 3G1 

Lightning, accidents from, 329 

Lime in the eyes 312 

"Liver-grown" in infants, 76 

Lochia, the, after confinement, 46 

"Longings," during pregnancy, ..... 13 

Lock-jaw, 76 

Lumbago, 382 

Lungs, bleeding from the, 408 

inflammation of the, or pneumonia, . 180 

Maggots in the navel .... 65 

Malaria, how to avoid 372 

Malarial fever (see intermittent fever), . 218 

Measles, 291 

treatment of, 293 

German, or rotheln, 295 

treatment of, -297 

Medicine, giving the 142 

Medicines, 355 

Meningitis, cerebrospinal, 238 

Milk, how to prepare for feeding, 103 

condensed 104 

sterilized, 108 

Milk-crust 267 

Milk fever 51 

Miscarriage, or abortion, 27 

Mothers' marks, 70 

Mother and physician, 133 

Mumps, 273 

Navel, bleeding from the, 66 

maggots in the, 65 

ulceration of the, 65 

Nephritic colic, 400 

Nettlerash, '260 

Nervous diseases 280 



418 



Index. 



Nervous disorders during teething, . . . 91-93 

Neuralgia, treatment of, 382 

Night terrors, . 242 

Nipples, during pregnancy 15 

sore, while nursing, 48 

Nostrils, closure of, in snuffles 168 

Nose, foreign bodies in the, 328 

bleeding from the 335 

Nursing the breast, 96 

from a bottle, 101 

Obsteuction of the bowels, in colic, . . . 403 

Oil, castor, how to give, 16 

uses of 363 

sweet, uses of, 363 

of vitriol, poisoning by, 318 

of wormseed, uses of, 199 

Opium, poisoning by, 320 

Overlying of infants, 69 

Oxalic acid, poisoning by, 319 

Oxide of zinc, uses of, 365 

Pain, its significance and treatment, ... 375 

in the abdomen 379-383 

'in angina pectoris, 378 

in the back, 378 

in the chest, 377 

in the extremities, 380 

in the head, 376 

in the heart, ..... 377-383 

x in the hips, 380-383 

in the joints, 332-384 

in hysteria, 384 

. in lumbago, 382 

in the neck, 376 

in pleurisy, 383 

in the spine, 378 

in sciatica, 384 

from distention of the abdomen in 

pregnancy 22 

Paint, white lead, use of, in burns 302 

Paralysis, in cerebro-spinal meningitis, . . 240 

in diphtheria, 281 

Paregoric, uses of, 363 

Paris green, poisoning by, 319 

Passions, importance of controlling the, . 373 

Peritonitis, 195 

treatment of, 197 

Pharyngitis, simple, or sore throat, .... 157 

follicular, U8 

Physician and mother, the, 133 

Phosphorus, poisoning by, 320 

Piles, during pregnancy, 18 

Placenta prsevia as a cause of hemorrhage, 26 

Pleurisy, acute, 185 

Chronic, 186 



Pleurisy, treatment of, 189 

Pleurodynia, 188 

Pleurisy with effusion, 187 

Pneumonia, or lung fever, 180 

treatment of, 183 

Poison ivy, 321 

Poisoning, internal, 316 

by acids, 317 

by oil of vitriol, . . 317 

by aquafortis, 317 

by arsenic, 319 

by belladonna, . 318 

by camphor, 318 

by corrosive sublimate, 318 

by hartshorn, 317 

by Jimson weed, 319 

by laudanum, 320 

by opium, 320 

by oxalic acid, 319 

by Paris green, 319 

by phosphorus 320 

by tartar emetic 321 

by white vitriol, 318 

Poisons, external, 321 

Poisonous insects, 322 

Prickly heat, 259 

Pregnancy, 11 

Premature infants, 67 

Prevention of disease, 367 

Prolapse of the bowel, 200 

Pruritus, or itching, 21 

Pulse, the, in health and disease, 153 

Purpura, 333 

hemorrhagica, 334 

Quicklime, as a disinfectant, 342 

Quiet in the sick room 141 

Bash, nettle, 260 

scarlet, 271 

Raw beef in rickets, 256 

Redgum, 261 

Remittent fever, 222 

Respiration in disease, 155 

Rhubarb, uses of, 363 

Rheumatism, pain in, . . 381 

Rickets, 254 

treatment of, 256 

Ringworm 262 

Rubeola, or measles,' 291 

Rotheln, or German measles 295 

Rupture in the new born, 75 

Salivation during pregnancy, 23 

Scaldhead, 262 

Scalds 299 

treatment of, 301 



Index. 



419 



Scarlet fever, 285 

treatment of, 289 

Scarlet rash, 271 

School-house, the 119 

Sciatica, treatment of, 384 

Scrofula, 249 

treatment of, 252 

Shingles 263 

Sick room, the 141 

Signs and symptoms of disease, 145 

Sleep in disease, ' . . 141 

in infancy and childhood 124 

Snake-bite 323 

Snuffles, 168 

Sore ears, 312 

Sore throat, 157 

Spina bifida 74 

Spitting of blood, 408 

Spotted fever, ..238 

Sprains, 309 

Still-born children, 52, 61 

Sting of insects 322 

Stomach, bleeding from, 411 

Stomach, diseases of, 191,202 

St. Vitus' dance, 232 

treatment of, 234 

Suffocation of children in bed 69 

Summer complaint, 202 

cholera infantum 202 

ileo-colitis, 205 

summer diarrhoea, 207 

Sunstroke, 406 

Swallowing foreign substances, 307 

Swelling of the limbs in pregnancy, . . . . 22 
Swelling on the head in the new-born, . . 64 
Syncope, or fainting, 404 

Tannin, uses of, 364 

Tartar emetic, poisoning by, 321 

Teeth, cutting the 87 

number of the 88 

Teething 86 

Temperature in disease, 154 

lower at night than in the day-time, . 124 

Thermometer, how to use the, 154 

Throat, sore, 157 

Thrush, 163 

in summer complaint, 214 



Tongue, appearance of, in disease, .... 152 

Tongue-tie, 65 

Tonsils, enlargement of the, 160 

Toothache during pregnancy, 19 

Typhoid fever (see infantile intermittent 

fever), . . . 222 

treatment of, 227 

Urine, incontinence of, 337 

retention of, 63 

Urethra, closure of the, 73 

Urticaria, or nettle rash, 260 

Vaccination, 331 

Varicella, or chicken pox, 297 

Vaseline, uses of, 365 

Ventilation in school-rooms, 119 

Vomiting blood 411 

in children, , 191 

in cholera infantum, 203 

during pregnancy 23 

Warts, 339 

Washing the child, . 56 

Water-brash during pregnancy 18 

Weaning, 109 

gradual HO 

when troublesome, 113 

causes that lead to early, 113 

Weed, the 51 

Wetting the bed, 337 

Wind colic, 402 

Wives, farmers', overworked 370 

White lead, uses of, 302, 361 

White vitriol, poisoning by 318 

Whooping cough, 274 

treatment of, 27/ 

Worms, 197 

Work, over, bad effects of, 369 

Wounds, 310 

incised, 310 

contused, 311 

punctured, .311 

Zinc, 365 

carbonate of, 365 

oxide of, . 365 

sulphate of, poisoning by, 318 



ADVERTISEMENTS. 



Everett Oladdey Co., 

-*PUBLISHERS*- 
PRINTERS AND BOOKBINDERS, 

1112, and 2600-2608 MAIN STREET, 
RICSM03NTD, ■\7'-A-. 

We ask special attention to the following books, which we have re- 
cently brought out. Sent by mail to any address on receipt of price. 

TOM AND JOE ; Two Farmer Boys in Love and War and Peace 
A Louisiana Memory. By Clarence B. Collins, the "Tom Sawyer'' of 
the Florida Press. Full Cloth, 12mo, 260 pp. Price, $1.00. Of this book 
it has been very truly said : " To the middle-aged and the old of our dear 
Southland it will bring back that happy period when our country lived 
its golden age— the glorious summer day that closed in storm and dark- 
ness ; to the young, it tells how their ancestors lived and loved and died; 
to those who loved and still love the " Lost Cause," it will recall the 
tenderest memories of a lifetime." 

YANKEE DOODLE DIXIE ; or, Love the Light of Life. Full 
cloth, 12mo, 540 pp Price, $1.25 By J. V. Ryals, of Virginia. A His- 
torical Romance, illustrative of life and love in an old Virginia country 
home, containing also an explanatory account of the passions, preju- 
dices and opinions which culminated in the civil war. 

" The work will reflect great credit on the talented author, not alone for the ability dis- 
played as a writer, but also for the ingenious manner in which he has interwoven history 
and romance." — Richmond Dispatch. 

"It is destined, we believe, to become popular with the great reading public, and to give 
to the talented author a high place in the ranks of Virginia writers. The work is an his- 
torical romance, and is altogether of thrilling interest. "—The Richmond State. 

"THE CHILD OF THE GANGES;" A Tale of the Judson 
Mission. By Rev. Robert N Barrett, Pastor Bethel Baptist Church, 
Fairview, Ky. Full cloth, 12mo, 358 pp ; $1.25. 

" Every chapter was fall of interest to me ; it is so full of information, historical and other, 
and told as really as if the author had lived through the times he describes. In my judg- 
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greater zeal for toreign missions."— Prof. J. P. Fruit, Prof. Eng. Lit., Bethel College, Russell- 
ville, Ky. 

"I received the book, and opened it the same evening, expecting to read a few chapters 
before retiring, but became so interested that I read it entirely through before laying it 
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"The story has something of the flavor of Ben-Hur about it. The narrative flows freely, 
affording opportune statements of facts and doctrine, and abounding in pleasing descriptive 
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"The language used is very fine, the style clear and easy, and the story is well told."— 
Baptist and Reflector, Nashville, Tain. 

THE MOTHER'S HAND-BOOK : A Practical Treatise on the 
Management of Children in Health and Disease ; with an Ap- 
pendix containing Articles on Diseases that may Suddenly Attack Grown 
Persons. By Levin J Woollen, M. D. Octavo, 422 pp. Cloth, $2 25 ; 
library sheep, $2.75. This is a book that should rind a place in every 
family. It has been written from a professional stand-point, by a prac- 
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gence. Elegantly printed in full octavo size, and bound in library sheep, 
with marble edges; also, in full cloth. 

Address orders to EVERETT WADDEY CO., 

Richmond, Va. 



3RS5' 



ADVERTISEMENTS. 



Do not fail to read our Proposition at the bottom of page.*i^-^ 

THE ONLY PERFECT 

ARTIFIC IAL INFAN T FOOD. 

It goes without saying that a child, to be perfectly nourished, should 
be fed on healthful human milk, or its equivalent, during the nursing 
period, or at least until seven months of age. If a child under seven 
months of age MUST be ARTIFICIALLY NOURISHED, 

LACTO-PREP AR AT A 

is the only Food which meets every requirement, as it is the only per- 
fect ARTIFICIAL HUMAN MILK ever produced ; when dissolved 
in luke-warm water it practically resembles human milk in composition, 
character and taste. 

It is made from pure cow's milk, contains no cereals in any form, and 
is treated according to the directions of PROF. ATTFIELD FOR 
STERILIZING MILK. 

L ACTO-PREP AR ATA and CARNRICK'S FOOD are now put up in 
air-tight cans ONLY, and will keep perfectly. 



CARNRICK'S FOOD 

is composed of two-thirds of LACTO-PREPARATA, and one-third of 
dextrinized wheat, and is more especially intended for children from 
seven months to two years of age. 



A PROPOSITION TO ANY PHYSICIAN. 

*The flesh of all children fed exclusively on LACTO-PREPARATA or 
CARNRICK'S FOOD is firm and solid, because these Foods contain the 
requisite amount of albuminoid constituents. 

The flesh of all children fed exclusively on any other Milk Foods 
(containing, as they do, 90 to 94 per cent, of cereals), is soft and flabby, 
because these Foods do not contain sufficient nitrogenous elements, 
and the children thus nourished will, in consequence, quickly collapse 
when attacked with any serious complaint. 

We respectfully request Physicians who are prescribing these Foods to 
examine the flesh of the Infants and verify our statements. 

We are so confident that our Foods are practically perfect as substi- 
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sician who is now prescribing other Foods or cow's milk, sufficient of our 
preparations to enable him to judge of their dietetic value in perfect 
nourishing qualities, as compared with other foods for similar purposes. 

REED & CARNRICK, 
Manufacturing Chemists, 

3XTEST7U" YORK. 



